HIV-Associated Cryptococcal Meningitis Patients Treated with Amphotericin B Deoxycholate Plus Flucytosine under Routine Care Conditions in a Referral Center in São Paulo, Brazil

José E. Vidal, Camila de Albuquerque Moraes, Renata Elisie Barbalho de Siqueira, Nathalya Fernanda Brito Miranda, Rosa Marcusso, David R. Boulware, Augusto C.Penalva de Oliveira

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Background: Cryptococcal meningitis remains a common cause of mortality in low- and middle-income countries, where amphotericin B deoxycholate (amphotericin) plus fluconazole is the most common treatment. Flucytosine is almost uniformly absent as is outcome data on flucytosine use in routine care. The main goal of this study was identified the cumulative mortality at 2, 4, and 10 weeks after hospital admission. Methods: We conducted a retrospective, observational cohort study among HIV-infected adults with cryptococcal meningitis receiving amphotericin plus flucytosine as induction therapy in Brazil. We assessed cumulative mortality at 2, 4, and 10 weeks and the cumulative proportion discontinuating amphotericin or flucytosine due to toxicity at 2 weeks. We performed multiple logistic regression to identify variables associated with in-hospital mortality. Results: In total, 77 individuals (n = 66 men) were included with median baseline CD4 of 29 (IQR, 9–68) cells/mcL. Twenty (26%) had at least one concurrent neurological disease diagnosed. Sixty (78%) patients received at least 14 days of amphotericin plus flucytosine. Cumulative mortality was 5% (4/77) at 2 weeks, 8% (6/77) at 4 weeks, and 19% (15/77) at 10 weeks. Cumulative proportion of patients that discontinuated amphotericin or flucytosine due to toxicity was 20% (16/77) at 2 weeks. In addition, in-hospital mortality was associated with receiving ≤ 10 days of induction therapy (odds ratio = 4.5, 95% CI 1.2–17.1, P = 0.028) or positive cerebrospinal fluid fungal culture after 2 weeks (odds ratio = 3.8, 95% CI 1.1–13.5, P = 0.035). Conclusion: In this “real-world” study, amphotericin plus flucytosine shows low early mortality of patients with HIV-associated cryptococcal meningitis. Early discontinuation due to adverse events was moderate. More effective and safe antifungals are needed in order to improve the outcome of cryptococcal meningitis.

Original languageEnglish (US)
Pages (from-to)93-102
Number of pages10
JournalMycopathologia
Volume186
Issue number1
DOIs
StatePublished - Nov 30 2020

Bibliographical note

Funding Information:
DRB is supported by the Fogarty International Center and National Institute of Neurologic Disorders and Stroke (R01NS086312-07).

Publisher Copyright:
© 2020, The Author(s), under exclusive licence to Springer Nature B.V. part of Springer Nature.

Keywords

  • Acquired immunodeficiency syndrome
  • Brazil
  • Cryptococcal meningitis
  • Cryptococcosis
  • Flucytosine
  • Treatment

PubMed: MeSH publication types

  • Journal Article
  • Observational Study

Fingerprint

Dive into the research topics of 'HIV-Associated Cryptococcal Meningitis Patients Treated with Amphotericin B Deoxycholate Plus Flucytosine under Routine Care Conditions in a Referral Center in São Paulo, Brazil'. Together they form a unique fingerprint.

Cite this