title: The use of HAART is associated with decreased risk of death during initial treatment of cryptococcal meningitis in adults in Botswana.
abstract: OBJECTIVE
  The objective of this study was to evaluate outcomes among adults with a first episode of cryptococcal meningitis (CM), comparing those on highly active antiretroviral therapy (HAART) with those not on HAART.
  
  
  METHODS
  We conducted a prospective cohort study among HIV-infected adults (aged 18 years and older) with a first episode of CM at the Princess Marina Hospital, in Gaborone, Botswana. The proportions surviving to discharge were compared. Logistic regression was used to evaluate the relationship between HAART use and risk of death in the hospital, adjusting for potential confounders.
  
  
  RESULTS
  Ninety-two patients [median CD4 41 cells/mm (interquartile range 22-85)] were included, 26 of whom were on HAART at the time that they developed CM. The in-hospital mortality was lower among those on HAART {2 of 26 (8%) vs 14 of 66 (21%); odds ratio = 0.36 [95% confidence interval (CI) 0.09 to 1.49]}, and this result was statistically significant after adjustment for male sex and tuberculosis [adjusted odds ratio = 0.19 (95% CI 0.04 to 1.00)].
  
  
  CONCLUSIONS
  HAART use at the time of a first admission with CM is associated with decreased risk of death during the acute phase of disease. Reasons for this association should be explored.
authors.affiliation: Department of Medicine, University of Pennsylvania School of Medicine, 423 Guardian Drive, Philadelphia, PA 19104, USA. gregbisson@mac.com
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Bisson
authors.forename: Rudo
authors.initials: R
authors.lastname: Nthobatsong
authors.forename: Rameshwari
authors.initials: R
authors.lastname: Thakur
authors.forename: Gloria
authors.initials: G
authors.lastname: Lesetedi
authors.forename: Kavita
authors.initials: K
authors.lastname: Vinekar
authors.forename: Pablo
authors.initials: P
authors.lastname: Tebas
authors.forename: John E
authors.initials: JE
authors.lastname: Bennett
authors.forename: Stephen
authors.initials: S
authors.lastname: Gluckman
authors.forename: Tendani
authors.initials: T
authors.lastname: Gaolathe
authors.forename: Rob R
authors.initials: RR
authors.lastname: MacGregor