title: A retrospective study of AIDS-associated cryptomeningitis.
abstract: Cryptococcal meningitis has emerged as a leading cause of infectious morbidity and mortality in patients with AIDS. A retrospective analysis of records of HIV-infected individuals registered in the Immunodeficiency Clinic of a tertiary care hospital and research institute was carried out. Records of 6900 HIV-infected individuals who were enrolled in the clinic between January 2002 and March 2011 were analyzed. Records of 6900 HIV-infected individuals were screened. Ninety-one were diagnosed with cryptococcal meningitis (1.32%). In 68 individuals cryptococcal meningitis was the presenting illness. Nine patients developed meningitis within 6 months of starting antiretroviral treatment (ART). Six patients were receiving ART for more than 6 months at the time of diagnosis. The remaining eight patients were not on ART at the time of development of meningitis. The mean baseline CD4 count of patients was 77.7 ± 61 (range, 4-259, n=91) cells/mm(3). Seventy-four patients had a CD4 value of less than 100 at the time of diagnosis of cryptococcal meningitis. Eleven of these ninety-one patients had a relapse of cryptococcal meningitis while receiving a maintenance dose of fluconazole. During follow-up 37 died, two were lost to follow-up, while 52 patients were on regular ART. Mortality due to cryptococcal meningitis amounted to 0.54% (37/6900). There was no correlation between survival and duration of ART at the time of cryptomeningitis (Pearsons χ(2)=0.241, p=0.884). There was a significant difference in the CD4 counts of the HIV-infected individuals who died with cryptomeningitis and those who survived (Pearson's χ(2)=9.1, df=4, p=0.05). The frequency of cryptococcal meningitis was 1.32%. Cryptococcal meningitis leads to high mortality in HIV patients. Management of cryptococcal infection remains a key facet of AIDS care in India.
authors.affiliation: Department of Internal Medicine, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
authors.forename: Ravinder Kaur
authors.initials: RK
authors.lastname: Sachdeva
authors.forename: Shivani
authors.initials: S
authors.lastname: Randev
authors.forename: Aman
authors.initials: A
authors.lastname: Sharma
authors.forename: Ajay
authors.initials: A
authors.lastname: Wanchu
authors.forename: Arunaloke
authors.initials: A
authors.lastname: Chakrabarti
authors.forename: Surjit
authors.initials: S
authors.lastname: Singh
authors.forename: Subhash
authors.initials: S
authors.lastname: Varma
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000276:immunology / Q000401:mortality*; D000328:Adult; D017677:Age Distribution; D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008499:Medical Records; D016919:Meningitis, Cryptococcal / Q000188:drug therapy / Q000209:etiology / Q000276:immunology / Q000401:mortality*; D008875:Middle Aged; D012189:Retrospective Studies; D017678:Sex Distribution; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B; D015725:Fluconazole