High Mortality in HIV-Associated Cryptococcal Meningitis Patients Treated With Amphotericin B–Based Therapy Under Routine Care Conditions in Africa
| Autor: | Mooketsi Molefi, Margaret Mokomane, Nametso Tlhako, Caitlin Azzo, Raju K. K. Patel, Joseph N Jarvis, Ephraim Tawanana, Mark W Tenforde, Katlego Tsholo, David Lawrence, Mosepele Mosepele, Tshepo B Leeme |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
sub-Saharan Africa
0301 basic medicine medicine.medical_specialty resource-limited settings Referral 030106 microbiology Major Articles Flucytosine 03 medical and health sciences 0302 clinical medicine cryptococcal meningitis Amphotericin B deoxycholate Internal medicine Amphotericin B medicine 030212 general & internal medicine business.industry Mortality rate Medical record HIV amphotericin B Confidence interval 3. Good health Infectious Diseases Oncology business Fluconazole medicine.drug |
| Zdroj: | Open Forum Infectious Diseases |
| ISSN: | 2328-8957 |
| DOI: | 10.1093/ofid/ofy267 |
| Popis: | BackgroundCryptococcal meningitis (CM) causes 10%–20% of HIV-related deaths in Africa. Due to limited access to liposomal amphotericin and flucytosine, most African treatment guidelines recommend amphotericin B deoxycholate (AmB-d) plus high-dose fluconazole; outcomes with this treatment regimen in routine care settings have not been well described.MethodsElectronic national death registry data and computerized medical records were used to retrospectively collect demographic, laboratory, and 1-year outcome data from all patients with CM between 2012 and 2014 at Botswana’s main referral hospital, when recommended treatment for CM was AmB-d 1 mg/kg/d plus fluconazole 800 mg/d for 14 days. Cumulative survival was estimated at 2 weeks, 10 weeks, and 1 year.ResultsThere were 283 episodes of CM among 236 individuals; 69% (163/236) were male, and the median age was 36 years. All patients were HIV-infected, with a median CD4 count of 39 cells/mm3. Two hundred fifteen person-years of follow-up data were captured for the 236 CM patients. Complete outcome data were available for 233 patients (99%) at 2 weeks, 224 patients (95%) at 10 weeks, and 219 patients (93%) at 1 year. Cumulative mortality was 26% (95% confidence interval [CI], 20%–32%) at 2 weeks, 50% (95% CI, 43%–57%) at 10 weeks, and 65% (95% CI, 58%–71%) at 1 year.ConclusionsMortality rates following HIV-associated CM treated with AmB-d and fluconazole in a routine health care setting in Botswana were very high. The findings highlight the inadequacies of current antifungal treatments for HIV-associated CM and underscore the difficulties of administering and monitoring intravenous amphotericin B deoxycholate therapy in resource-poor settings. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|