title: Long-term follow-up and survival of antiretroviral-naive patients with cryptococcal meningitis in the pre-antiretroviral therapy era, Gauteng Province, South Africa.
abstract: Cryptococcal meningitis (CM) is a major cause of death among HIV-infected persons in sub-Saharan Africa. We conducted a study to describe the long-term outcomes during the pre-antiretroviral post-ART therapy period. Enrolled cases were those detected through population-based surveillance in Gauteng Province, South Africa, and diagnosed during March-November 2002 and July-September 2003 from eight large hospitals representing academic, provincial and rural settings. Of 1089 case-patients diagnosed with CM, 721 (70%) survived to discharge. Among the 256 with follow-up information, 154 (60%) were established to have died, 44% of whom died as outpatients. Overall, the 14- and 90-day survival post-diagnosis was 68% and 41%, respectively. On Cox proportional hazards multivariable analysis, severe disease was associated with shorter survival time; having received any antifungal treatment for the cryptococcal episode was associated with increased survival time at follow-up. Although most patients in this cohort survived the initial hospitalization, only 41% were still alive three months after diagnosis, with nearly half of deaths occurring outside a hospital. These data are an important baseline from which to measure effectiveness of public health management of CM in South Africa.
authors.affiliation: Mycotic Diseases Branch, US Centers for Disease Control and Prevention, Atlanta, GA, USA. bpark1@cdc.gov
authors.forename: B J
authors.initials: BJ
authors.lastname: Park
authors.forename: S
authors.initials: S
authors.lastname: Shetty
authors.forename: A
authors.initials: A
authors.lastname: Ahlquist
authors.forename: A
authors.initials: A
authors.lastname: Greenbaum
authors.forename: J L
authors.initials: JL
authors.lastname: Miller
authors.forename: A
authors.initials: A
authors.lastname: Motsi
authors.forename: K
authors.initials: K
authors.lastname: McCarthy
authors.forename: N
authors.initials: N
authors.lastname: Govender
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use; D003695:Delivery of Health Care; D005260:Female; D015725:Fluconazole; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D008297:Male; D016919:Meningitis, Cryptococcal / Q000150:complications / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D016016:Proportional Hazards Models; D013019:South Africa / Q000453:epidemiology; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents; D000935:Antifungal Agents; D015725:Fluconazole