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Member Research & Reports

Member Research & Reports

UAB Assesses Clinical Management and Mortality Associated with CM in AIDS Patients

Cryptococcal meningitis (CM) is an increasingly prevalent infection among acquired immunodeficiency syndrome (AIDS) patients and is a leading cause of morbidity and mortality in Africa. The short-term prognosis and management of patients with CM may be improved by identifying factors leading to mortality in CM patients. Dr. Pauline E. Jolly, professor in the department of epidemiology at the University of Alabama at Birmingham — along with Dr. Inmaculada Aban, professor in UAB’s department of biostatistics, and Drs. Peter G. Pappas and John W. Baddley, professors in the division of infectious diseases — conducted a retrospective chart review of 76 human immunodeficiency virus (HIV)-infected CM patients admitted between August 2008 and March 2009 at Kenyatta National Hospital and Mbagathi District Hospital to assess the clinical management and mortality associated with CM in AIDS patients in Kenya.

[Photo: Dr. Pauline E. Jolly]

Results show that 30 (40 percent) of the 76 patients diagnosed with CM died during hospitalization after a median hospital stay of 10 days (range, 2-73 days). Significant predictors of mortality in univariate analysis were Mycobacterium tuberculosis (TB) co-infection, having been diagnosed with a co-morbid condition such as diabetes, oral candidiasis, or hypertension, and a low median CD4+ T lymphocyte count. The multivariable model revealed that male sex, previous or current antiretroviral therapy (ART) at admission, and CD4+ T lymphocyte count less than 50 were significant predictors of mortality. Conversely, a minimum of two weeks of amphotericin B treatment, initiation of ART, and monitoring of creatinine and electrolyte levels were significantly associated with survival by univariate analysis.

These results demonstrate that the CM-associated mortality in Kenya is high and that there is an opportunity to improve the management and the short-term outcomes of hospitalized HIV positive patients with CM.

“Mortality After Clinical Management of AIDS-Associated Cryptococcal Meningitis in Kenya” was published online in May 2014 in the East African Medical Journal.

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