ArticleHIV medicine2017
Prognostic implications of baseline anaemia and changes in haemoglobin concentrations with amphotericin B therapy for cryptococcal meningitis.
Article in HIV medicine, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
21 citing papers in PubMed, 1 synthesis or guideline pooled it, 30 citations in OpenAlex.
- Prevalence of cryptococcal meningitis among people living with human immuno-deficiency virus and predictors of mortality in adults on induction therapy in Africa: A systematic review and meta-analysis.Frontiers in medicine · 2022Pooled it
- Oral Lipid Nanocrystal Amphotericin B for Cryptococcal Meningitis: A Randomized Clinical Trial.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Trial
- How Applicable Is the Single-Dose AMBITION Regimen for Human Immunodeficiency Virus-Associated Cryptococcal Meningitis to High-Income Settings?Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Trial
- Article
- Cerebral Perfusion Pressures and Implications on Clinical Outcomes and Medical Management in Cryptococcal Meningitis.Open forum infectious diseases · 2025Article
- Safety of different amphotericin B formulations among AIDS patients with invasive fungal disease: a retrospective observational study.AIDS research and therapy · 2024Observational
- Mid-Upper Arm Circumference Is a Strong Predictor of Mortality Among Ugandan Adults With HIV-Associated Cryptococcal Meningitis: A Prospective Cohort Study.Open forum infectious diseases · 2024Article
- Diagnosis and management of cryptococcal meningitis in HIV-infected adults.Clinical microbiology reviews · 2023Review
- Cryptococcal meningitis.Nature reviews. Disease primers · 2023Review
- Therapeutic Lumbar Punctures in Human Immunodeficiency Virus-Associated Cryptococcal Meningitis: Should Opening Pressure Direct Management?Open forum infectious diseases · 2022Article
- Cerebrospinal Fluid Lactate as a Prognostic Marker of Disease Severity and Mortality in Cryptococcal Meningitis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Article
- Impact of biological sex on cryptococcal meningitis mortality in Uganda and South Africa.Medical mycology · 2021Observational
- Three-year mortality in cryptococcal meningitis: Hyperglycemia predict unfavorable outcome.PloS one · 2021Article
- Cerebrospinal Fluid Early Fungicidal Activity as a Surrogate Endpoint for Cryptococcal Meningitis Survival in Clinical Trials.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2020Article
- Review
- Cytomegalovirus Viremia Associated With Increased Mortality in Cryptococcal Meningitis in Sub-Saharan Africa.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2020Article
- Tuberculosis in HIV-Associated Cryptococcal Meningitis is Associated with an Increased Risk of Death.Journal of clinical medicine · 2020Article
- Diagnosis and Management of Central Nervous System Cryptococcal Infections in HIV-Infected Adults.Journal of fungi (Basel, Switzerland) · 2019Review
- Cerebral Oximetry for Detecting High-mortality Risk Patients with Cryptococcal Meningitis.Open forum infectious diseases · 2018Article
- Ophthalmic signs in Ugandan adults with HIV-associated cryptococcal meningitis: A nested analysis of the ASTRO-CM cohort.Wellcome open research · 2018Article
Corrections and comments
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Authors and funding
17 authors at 5 institutions in 4 countries.
Funding
Abstract
objectivesAnaemia represents a common toxicity with amphotericin B-based induction therapy in HIV-infected persons with cryptococcal meningitis. We sought to examine the impact of amphotericin-related anaemia on survival.
methodsWe used data from Ugandan and South African trial participants to characterize the variation of haemoglobin concentrations from diagnosis to 12 weeks post-diagnosis. Anaemia severity was classified based on the haemoglobin concentration at cryptococcal meningitis diagnosis, and nadir haemoglobin values during amphotericin induction. Cox proportional hazard models were used to estimate 2- and 10-week mortality risk. We also estimated 10-week mortality risk among participants with nadir haemoglobin < 8.5 g/dL during amphotericin induction and who survived ≥ 2 weeks post-enrolment.
resultsThe median haemoglobin concentration at meningitis diagnosis was 11.5 g/dL [interquartile range (IQR) 9.7-13 g/dL; n = 311] with a mean decline of 4.2 g/dL [95% confidence interval (CI) -4.6 to -3.8; P < 0.001; n = 148] from diagnosis to nadir value among participants with baseline haemoglobin ≥ 8.5 g/dL. The median haemoglobin concentration was 8.1 g/dL (IQR 6.5-9.5 g/dL) at 2 weeks, increasing to 9.4 g/dL (IQR 8.2-10.9 g/dL) by 4 weeks and continuing to increase to 12 weeks. Among participants with haemoglobin < 8.5 g/dL at diagnosis, mortality risk was elevated at 2 weeks [hazard ratio (HR) 2.7; 95% CI 1.5-4.9; P < 0.01] and 10 weeks (HR 1.8; 95% CI 1.1-2.2; P = 0.03), relative to those with haemoglobin ≥ 8.5 g/dL. New-onset anaemia occurring with amphotericin therapy did not have a statistically significant association with 10-week mortality (HR 2.0; 95% CI 0.5-9.1; P = 0.4).
conclusionsAmphotericin induced significant haemoglobin declines, which were mostly transient and did not impact 10-week mortality. Individuals with moderate to life-threatening anaemia at baseline had a higher mortality risk at 2 and 10 weeks post-enrolment.
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