Discontinuation of maintenance therapy for cryptococcal meningitis in patients with AIDS treated with highly active antiretroviral therapy: an international observational study.
We conducted a retrospective, multicenter study evaluating the safety of discontinuing maintenance therapy for cryptococcal meningitis after immune reconstitution. Inclusion criteria were a previous definitive diagnosis of cryptococcal meningitis, a CD4 cell count of >100 cells/microL while receiving highly active antiretroviral therapy (HAART), and the subsequent discontinuation of maintenance therapy for cryptococcal meningitis. The primary end point was relapse of cryptococcal disease. As of July 2002, 100 patients were enrolled. When maintenance therapy was discontinued, the median CD4 cell count was 259 cells/microL and the median plasma virus load was <2.30 log10 copies/mL, and serum cryptococcal antigen was undetectable in 56 patients. During a median follow-up period of 28.4 months (range, 6.7-64.5; 262 person-years), 4 events were observed (incidence, 1.53 events per 100 person-years; 95% confidence interval, 0.42-3.92). Three of these patients had a CD4 cell count of >100 cells/microL and a positive serum cryptococcal antigen test result during the recurrent episode. In conclusion, discontinuation of maintenance therapy for cryptococcal meningitis is safe if the CD4 cell count increases to >100 cells/microL while receiving HAART. Recurrent cryptococcal infection should be suspected in patients whose serum cryptococcal antigen test results revert back to positive after discontinuation of maintenance therapy.
Mussini
Cristina
C
Clinic of Infectious and Tropical Diseases, University of Modena and Reggio Emilia, Azienda Policlinico, Modena, Italy. crimuss@unimo.it
Pezzotti
Patrizio
P
Miró
José M
JM
Martinez
Esteban
E
de Quiros
Juan Carlos Lopez Bernaldo
JC
Cinque
Paola
P
Borghi
Vanni
V
Bedini
Andrea
A
Domingo
Pere
P
Cahn
Pedro
P
Bossi
Philippe
P
de Luca
Andrea
A
d'Arminio Monforte
Antonella
A
Nelson
Mark
M
Nwokolo
Nneka
N
Helou
Silvia
S
Negroni
Ricardo
R
Jacchetti
Gaia
G
Antinori
Spinello
S
Lazzarin
Adriano
A
Cossarizza
Andrea
A
Esposito
Roberto
R
Antinori
Andrea
A
Aberg
Judith A
JA
D017088:AIDS-Related Opportunistic Infections / Q000382:microbiology*; D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000276:immunology*; D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000946:Antigens, Fungal / Q000032:analysis; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D006801:Humans; D008297:Male; D016919:Meningitis, Cryptococcal / Q000188:drug therapy / Q000276:immunology*; D008875:Middle Aged; D012189:Retrospective Studies; D019562:Viral Load
D019380:Anti-HIV Agents; D000946:Antigens, Fungal