title: Discontinuation of maintenance therapy for cryptococcal meningitis in patients with AIDS treated with highly active antiretroviral therapy: an international observational study.
abstract: 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.
authors.affiliation: Clinic of Infectious and Tropical Diseases, University of Modena and Reggio Emilia, Azienda Policlinico, Modena, Italy. crimuss@unimo.it
authors.forename: Cristina
authors.initials: C
authors.lastname: Mussini
authors.forename: Patrizio
authors.initials: P
authors.lastname: Pezzotti
authors.forename: José M
authors.initials: JM
authors.lastname: Miró
authors.forename: Esteban
authors.initials: E
authors.lastname: Martinez
authors.forename: Juan Carlos Lopez Bernaldo
authors.initials: JC
authors.lastname: de Quiros
authors.forename: Paola
authors.initials: P
authors.lastname: Cinque
authors.forename: Vanni
authors.initials: V
authors.lastname: Borghi
authors.forename: Andrea
authors.initials: A
authors.lastname: Bedini
authors.forename: Pere
authors.initials: P
authors.lastname: Domingo
authors.forename: Pedro
authors.initials: P
authors.lastname: Cahn
authors.forename: Philippe
authors.initials: P
authors.lastname: Bossi
authors.forename: Andrea
authors.initials: A
authors.lastname: de Luca
authors.forename: Antonella
authors.initials: A
authors.lastname: d'Arminio Monforte
authors.forename: Mark
authors.initials: M
authors.lastname: Nelson
authors.forename: Nneka
authors.initials: N
authors.lastname: Nwokolo
authors.forename: Silvia
authors.initials: S
authors.lastname: Helou
authors.forename: Ricardo
authors.initials: R
authors.lastname: Negroni
authors.forename: Gaia
authors.initials: G
authors.lastname: Jacchetti
authors.forename: Spinello
authors.initials: S
authors.lastname: Antinori
authors.forename: Adriano
authors.initials: A
authors.lastname: Lazzarin
authors.forename: Andrea
authors.initials: A
authors.lastname: Cossarizza
authors.forename: Roberto
authors.initials: R
authors.lastname: Esposito
authors.forename: Andrea
authors.initials: A
authors.lastname: Antinori
authors.forename: Judith A
authors.initials: JA
authors.lastname: Aberg
mesh_terms: 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
chemical_list: D019380:Anti-HIV Agents; D000946:Antigens, Fungal