title: Successful salvage therapy of refractory HIV-related cryptococcal meningitis with the combination of liposomal amphotericin B, voriconazole, and recombinant interferon-γ.
abstract: We present 2 cases of HIV-related cryptococcal meningitis, persisting after 3 and 9 months, respectively, of standard treatment. Both patients were treated successfully with a salvage regimen consisting of the combination of liposomal amphotericin B (3 mg/kg), intravenous voriconazole, and subcutaneous recombinant interferon γ-1b (200 μg thrice weekly). Voriconazole was administered at an increased dose (5 mg/kg, twice daily) to overcome interactions with co-administered ritonavir. In both patients, resolution of clinical signs and symptoms, as well as sterilization of cerebrospinal fluid cultures occurred after 10 weeks of salvage therapy. No major side effects were encountered. At the end of treatment, both patients were placed on maintenance therapy with oral fluconazole; no recurrence has been observed after 4 years of follow-up.
authors.affiliation: Department of Pathophysiology (AIDS Unit), Laikon General Hospital and Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Maria N
authors.initials: MN
authors.lastname: Gamaletsou
authors.forename: Nikolaos V
authors.initials: NV
authors.lastname: Sipsas
authors.forename: Dimitrios P
authors.initials: DP
authors.lastname: Kontoyiannis
authors.forename: Aristotelis
authors.initials: A
authors.lastname: Tsiakalos
authors.forename: Athanasios N
authors.initials: AN
authors.lastname: Kontos
authors.forename: Ioanna
authors.initials: I
authors.lastname: Stefanou
authors.forename: Theodore
authors.initials: T
authors.lastname: Kordossis
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage*; D000935:Antifungal Agents / Q000008:administration & dosage*; D004359:Drug Therapy, Combination / Q000379:methods; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007371:Interferon-gamma / Q000008:administration & dosage*; D008297:Male; D016919:Meningitis, Cryptococcal / Q000188:drug therapy*; D008875:Middle Aged; D011743:Pyrimidines / Q000008:administration & dosage*; D016879:Salvage Therapy / Q000379:methods*; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage*; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; C068538:liposomal amphotericin B; D000666:Amphotericin B; D007371:Interferon-gamma; D065819:Voriconazole