title: Outcome of HIV-1-associated cryptococcal meningitis, Denmark 1988-2008.
abstract: BACKGROUND
  The risk of HIV-1-associated Cryptococcus neoformans meningitis (CM) has decreased and the outcome has improved with the use of combination antiretroviral therapy (cART). Outcome has not been reported in Denmark in the cART era.
  
  
  METHODS
  A review of all cases of HIV-1-associated CM treated at 2 hospitals in Denmark was carried out. Survival was compared by time-updated Cox proportional hazards analysis.
  
  
  RESULTS
  A total of 45 cases were evaluated. Six individuals (13.3%) died within 30 days of being diagnosed with CM. cART was initiated a median of 15 days (range 3-53) after a diagnosis of CM for 12 individuals and did not affect 30-day outcome. Older age, however, was associated with an increased risk of death at 30 days (mortality rate ratio (MMR) 1.16 (95% confidence interval (95% CI) 1.05-1.30) per y increment). Twenty-four (55.8%) of 43 individuals (2 had emigrated) died within the 1(st) y. Initiation of cART significantly improved 1-y outcome (MMR 0.22, 95% CI 0.06-0.77). Mental status, CD4 T cell count, and antifungal did not affect short- or long-term outcome.
  
  
  CONCLUSIONS
  We found that long-term survival after HIV-1-associated CM has improved significantly with the use of cART. Short-term mortality was not affected by initiation of cART and remained high.
authors.affiliation: Department of Infectious Diseases, Hvidovre University Hospital, Hvidovre, Denmark.
authors.forename: Inger Hee Mabuza
authors.initials: IH
authors.lastname: Mathiesen
authors.forename: Jenny Dahl
authors.initials: JD
authors.lastname: Knudsen
authors.forename: Jan
authors.initials: J
authors.lastname: Gerstoft
authors.forename: Susan
authors.initials: S
authors.lastname: Cowan
authors.forename: Thomas
authors.initials: T
authors.lastname: Benfield
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy*; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D000935:Antifungal Agents / Q000008:administration & dosage*; D003718:Denmark; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D016919:Meningitis, Cryptococcal / Q000188:drug therapy* / Q000401:mortality*; D008875:Middle Aged; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents; D000935:Antifungal Agents