title: Poor long-term outcomes for cryptococcal meningitis in rural South Africa.
abstract: OBJECTIVE
  To explore linkage to and retention in HIV care after an episode of cryptococcal meningitis (CM) in rural South Africa. Design. A retrospective case series of adult individuals (> or = 16 years old) with laboratory-confirmed CM from January - December 2007 at Hlabisa Hospital--a district hospital in northern KwaZulu-Natal.
  
  
  METHODS
  Inpatient mortality and associated risk factors were analysed. The proportion alive and on antiretroviral therapy (ART) at 2 years was determined by linkage to the HIV treatment programme.
  
  
  RESULTS
  One hundred and four individuals were identified with laboratory diagnosis of CM; 74/104 (71.2%) with complete records were included in the analysis. Inpatient mortality was high (40.5%) and was significantly associated with reduced conscious level (aHR 3.09, 95% CI 1.30 - 7.33) and absence of headache (aHR 0.33 for headache, 95% CI 0.13 - 0.87). Only 8 individuals (10.8% of all study subjects) were alive and receiving ART 2 years after the CM episode.
  
  
  CONCLUSIONS
  Long-term outcomes of CM are poor in routine practice. Interventions to strengthen linkage to HIV treatment and care and continuation of secondary fluconazole prophylaxis are critical.
authors.affiliation: Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, KwaZulu-Natal. rlessells@africacentre.ac.za
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Lessells
authors.forename: Portia C
authors.initials: PC
authors.lastname: Mutevedzi
authors.forename: Tom
authors.initials: T
authors.lastname: Heller
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Newell
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D008297:Male; D016919:Meningitis, Cryptococcal / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality*; D011379:Prognosis; D012424:Rural Population; D013019:South Africa; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B; D015725:Fluconazole