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Abstract
Introduction: 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 1st 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.
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Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
Notice of correction
Please note changes have been made to Table I from its Early Online publication 13 November 2011: Column ‘30-day non-survivors N=6’, rows ‘Period 1988–1996’ and ‘Period 1997–2008’. Column ‘30-day survivors N=39’, rows ‘Male, n (%)’, ‘Period 1988–1996’ and ‘Period 1997–2008’.