title: Cryptococcal meningitis in HIV-infected patients: a longitudinal study in Cambodia.
abstract: OBJECTIVE
  To describe the frequency of diagnosis of cryptococcosis among HIV-infected patients in Phnom Penh, Cambodia, at programme entry, to investigate associated risk factors, and to determine the incidence of cryptococcal meningitis.
  
  
  METHODS
  We analysed individual monitoring data from 11,970 HIV-infected adults enrolled between 1999 and 2008. We used Kaplan-Meier naïve methods to estimate survival and retention in care and multiple logistic regression to investigate associations with individual-level factors.
  
  
  RESULTS
  Cryptococcal meningitis was diagnosed in 12.0% of the patients: 1066 at inclusion and 374 during follow-up. Incidence was 20.3 per 1000 person-years and decreased over time. At diagnosis, median age was 33 years, median CD4 cell count was 8 cells/μl, and 2.4% of patients were receiving combined antiretroviral therapy; 38.7% died and 34.6% were lost to follow-up. Of 750 patients alive and in care after 3 months of diagnosis, 85.9% received secondary cryptococcal meningitis prophylaxis and 13.7% relapsed in median 5.7 months [interquartile range 4.1-8.8] after cryptococcal meningitis diagnosis (relapse incidence=5.7 per 100 person-years; 95%CI 4.7-6.9). Cryptococcal meningitis was more common in men at programme entry (adjusted OR=2.24, 95% CI 1.67-3.00) and fell with higher levels of CD4 cell counts (P<0.0001).
  
  
  CONCLUSIONS
  Cryptococcal meningitis remains an important cause of morbidity and mortality in Cambodian HIV-infected patients. Our findings highlight the importance of increasing early access to HIV care and cryptococcal meningitis prophylaxis and of improving its diagnosis in resource-limited settings.
authors.affiliation: Epicentre, Médecins Sans Frontières, 8 rue Saint Sabin, Paris, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Espié
authors.forename: Loretxu
authors.initials: L
authors.lastname: Pinoges
authors.forename: Suna
authors.initials: S
authors.lastname: Balkan
authors.forename: Ngeth
authors.initials: N
authors.lastname: Chanchhaya
authors.forename: Lucas
authors.initials: L
authors.lastname: Molfino
authors.forename: Prak
authors.initials: P
authors.lastname: Narom
authors.forename: Mar
authors.initials: M
authors.lastname: Pujades-Rodríguez
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data; D015992:Body Mass Index; D018791:CD4 Lymphocyte Count; D002160:Cambodia / Q000453:epidemiology; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D008297:Male; D016919:Meningitis, Cryptococcal / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control; D012008:Recurrence; D017678:Sex Distribution; D016896:Treatment Outcome; D055815:Young Adult