Observational studyInternational journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases2017
Outcomes of HIV-positive patients with cryptococcal meningitis in the Americas.
Observational study in International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 2 of them syntheses that pooled it.
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The trial behind it
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
18 citing papers in PubMed, 2 syntheses or guidelines pooled it, 29 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
- Early versus delayed antiretroviral treatment in HIV-positive people with cryptococcal meningitis.The Cochrane database of systematic reviews · 2018Pooled it
- The Caribbean, Central and South America Network for HIV Epidemiology: 20 Years of HIV Research in the Region.Journal of the International AIDS Society · 2026Article
- Article
- Access to diagnostic testing for invasive fungal diseases and other opportunistic infections in Mexican health care centers caring for patients living with HIV.BMC health services research · 2025Article
- Early Antiretroviral Therapy Not Associated With Higher Cryptococcal Meningitis Mortality in People With Human Immunodeficiency Virus in High-Income Countries: An International Collaborative Cohort Study.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Article
- Cryptococcal Meningitis and Clinical Outcomes in Persons With Human Immunodeficiency Virus: A Global View.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Article
- DectiSomes: C-type lectin receptor-targeted liposomes as pan-antifungal drugs.Advanced drug delivery reviews · 2023Review
- Late-onset opportunistic infections while receiving anti-retroviral therapy in Latin America: burden and risk factors.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2022Article
- Evaluation of the initial 12 months of a routine cryptococcal antigen screening program in reduction of HIV-associated cryptococcal meningitis in Uganda.BMC health services research · 2022Article
- High Burden of Cryptococcal Meningitis Among Antiretroviral Therapy-Experienced Human Immunodeficiency Virus-Infected Patients in Northern Uganda in the Era of "Test and Treat": Implications for Cryptococcal Screening Programs.Open forum infectious diseases · 2022Article
- Article
- HIV-Associated Cryptococcal Meningitis Patients Treated with Amphotericin B Deoxycholate Plus Flucytosine under Routine Care Conditions in a Referral Center in São Paulo, Brazil.Mycopathologia · 2021Observational
- A single-centre, retrospective study of the incidence of invasive fungal infections during 85 years of autopsy service in Brazil.Scientific reports · 2021Article
- The Effect of Early vs. Deferred Antiretroviral Therapy Initiation in HIV-Infected Patients With Cryptococcal Meningitis: A Multicenter Prospective Randomized Controlled Analysis in China.Frontiers in medicine · 2021Article
- Prevalence of Cryptococcal Antigen and Outcomes in People With Human Immunodeficiency Virus in Honduras: A Cohort Study.Open forum infectious diseases · 2021Article
- Cryptococcus neoformans infection in Human Immunodeficiency Virus (HIV)-infected and HIV-uninfected patients at an inner-city tertiary care hospital in the Bronx.Medical mycology · 2020Article
- The status of cryptococcosis in Latin America.Memorias do Instituto Oswaldo Cruz · 2018Review
Corrections and comments
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Authors and funding
12 authors at 5 institutions in 5 countries.
Funding
Abstract
backgroundCryptococcal meningitis (CM) is associated with substantial mortality in HIV-infected patients. Optimal timing of antiretroviral therapy (ART) in persons with CM represents a clinical challenge, and the burden of CM in Latin America has not been well described. Studies suggest that early ART initiation is associated with higher mortality, but data from the Americas are scarce.
methodsHIV-infected adults in care between 1985-2014 at participating sites in the Latin America (the Caribbean, Central and South America network (CCASAnet)) and the Vanderbilt Comprehensive Care Clinic (VCCC) and who had CM were included. Survival probabilities were estimated. Risk of death when initiating ART within the first 2 weeks after CM diagnosis versus initiating between 2-8 weeks was assessed using dynamic marginal structural models adjusting for site, age, sex, year of CM, CD4 count, and route of HIV transmission.
findings340 patients were included (Argentina 58, Brazil 138, Chile 28, Honduras 27, Mexico 34, VCCC 55) and 142 (42%) died during the observation period. Among 151 patients with CM prior to ART 56 (37%) patients died compared to 86 (45%) of 189 with CM after ART initiation (p=0.14). Patients diagnosed with CM after ART had a higher risk of death (p=0.03, log-rank test). The probability of survival was not statistically different between patients who started ART within 2 weeks of CM (7/24, 29%) vs. those initiating between 2-8 weeks (14/53, 26%) (p=0.96), potentially due to lack of power.
interpretationIn this large Latin-American cohort, patients with CM had very high mortality rates, especially those diagnosed after ART initiation. This study reflects the overwhelming burden of CM in HIV-infected patients in Latin America.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.