Factors associated with early mycological clearance in HIV-associated cryptococcal meningitis
| Autor: | Elsa González-Lagos, Carlos Seas, Fátima Concha-Velasco, Beatriz Bustamante |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
RNA viruses
Male 0301 basic medicine Antifungal Agents Physiology Colony Count Microbial lcsh:Medicine HIV Infections Meningitis Cryptococcal Pathology and Laboratory Medicine Nervous System Flucytosine 0302 clinical medicine Immunodeficiency Viruses Infectious Diseases of the Nervous System Risk Factors Amphotericin B Amphotericin B deoxycholate Medicine and Health Sciences Public and Occupational Health 030212 general & internal medicine lcsh:Science Amphotericin Fluconazole Cerebrospinal Fluid Multidisciplinary HIV Infections/drug therapy/immunology/microbiology Antimicrobials Drugs Fluconazole/therapeutic use Vaccination and Immunization Body Fluids 3. Good health Cryptococcal Meningitis Drug Combinations Infectious Diseases Treatment Outcome Neurology Medical Microbiology Viral Pathogens Viruses Antifungal Agents/therapeutic use Drug Therapy Combination Female Anatomy Pathogens Meningitis Research Article Deoxycholic Acid medicine.drug Adult medicine.medical_specialty Combination therapy Death Rates Immunology 030106 microbiology Amphotericin B/therapeutic use Antiretroviral Therapy Mycology Meningitis Cryptococcal/drug therapy/immunology/microbiology purl.org/pe-repo/ocde/ford#3.03.08 [https] Microbiology AIDS-Related Opportunistic Infections/drug therapy/immunology/microbiology Immunocompromised Host 03 medical and health sciences Pharmacotherapy Antiviral Therapy purl.org/pe-repo/ocde/ford#3.03.02 [https] Microbial Control Internal medicine Retroviruses medicine Humans purl.org/pe-repo/ocde/ford#3.01.055 [https] Microbial Pathogens Demography Retrospective Studies Pharmacology Antifungals AIDS-Related Opportunistic Infections business.industry lcsh:R Lentivirus Organisms Fungi Biology and Life Sciences HIV Deoxycholic Acid/therapeutic use Retrospective cohort study medicine.disease Cryptococcus People and Places lcsh:Q Preventive Medicine business |
| Zdroj: | PLoS ONE PLoS ONE, Vol 12, Iss 3, p e0174459 (2017) |
| ISSN: | 1932-6203 |
| DOI: | 10.1371/journal.pone.0174459 |
| Popis: | Introduction The first-line combination therapy for HIV-associated cryptococcal meningitis (CM), a condition of high mortality particularly in the first two weeks of treatment, consists of amphotericin B plus flucytosine (5-FC). Given that 5-FC remains unavailable in many countries, the knowledge of factors influencing mycological clearance in patients treated with second-line therapy could contribute to effective management. Objectives To determine the factors associated with the clearance of Cryptococcus sp. from the cerebrospinal fluid by the second week of effective antifungal therapy (early mycological clearance) in HIV-associated CM. Methods Retrospective cohort study based on secondary data corresponding to HIV-associated CM cases hospitalized at a tertiary health care center in Lima, Peru where 5-FC remains unavailable. Risk factors associated with early mycological clearance were analyzed by generalized linear regression models. Results From January 2000 to December 2013, 234 individuals were discharged with a diagnosis of HIV-associated CM; in 215 we retrieved the required data. The inpatient mortality was 20% (43/215), 15 of them in the first two weeks of treatment. In the final model (157 cases), adjusted for age, previous episode of CM, ART use, type of antifungal treatment, raised intracranial pressure, frequency of therapeutic lumbar punctures, baseline fungal burden and treatment period, the factors associated with early mycological clearance were: Amphotericin B deoxycholate plus fluconazole as combination therapy (RR, 1.56; 95% CI, 1.14-2.14); severe baseline intracranial pressure (≥35 cm H2O) (RR, 0.57; 95% CI, 0.33-0.99); and baseline fungal burden over 4.5 log10 CFU/mL (RR, 0.61 95% CI: 0.39-0.95). Conclusions In a setting without access to first-line therapy for CM, the combination therapy with amphotericin B deoxycholate plus fluconazole was positively associated with early mycological clearance, while high fungal burden and severe baseline intracranial pressure were negatively associated, and thus related to failure. |
| Databáze: | OpenAIRE |
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