Ramírez BC, et al. – This work sought to present a description of clinical outcomes of cryptococcal meningitis (CM) in persons with HIV–infection in a large Latin–American cohort. Observations revealed very high mortality rates in this population. The mortality was especially high among those diagnosed after antiretroviral therapy (ART) initiation. Findings thereby suggested very high burden of CM in HIV–infected patients in Latin America.

Methods

• This study included HIV–infected adults in care between 1985–2014 at participating sites in the Latin America (the Caribbean, Central and South America network (CCASAnet)) and the Vanderbilt Comprehensive Care Clinic (VCCC) and who had CM.
• Authors determined survival probabilities.
• Using dynamic marginal structural models adjusting for site, age, sex, year of CM, CD4 count, and route of HIV transmission, they assessed risk of death when initiating ART within the first 2 weeks after CM diagnosis versus initiating between 2–8 weeks.

Results

• This study included 340 patients(Argentina 58, Brazil 138, Chile 28, Honduras 27, Mexico 34, VCCC 55) and 142 (42%) died during the observation period.
• 56 (37%) of 151 patients with CM prior to ART initiation died compared to 86 (45%) of 189 with CM after ART initiation (p = 0.14).
• Observations revealed higher risk of death (p = 0.03, log–rank test) among patients diagnosed with CM after ART.
• No statistical difference regarding the probability of survival was observed between patients who started ART within 2 weeks of CM (7/24, 29%) vs. those initiating between 2–8 weeks (14/53, 26%) (p = 0.96), potentially due to lack of power.