Evidence map›Paper›PMID 36123803›Full record

SynthesisHIV medicine2023

An updated systematic review of HIV-associated cryptococcal meningitis treatment strategies.

Adrienne E Shapiro, Mark W Tenforde, Tom M Chiller, Nathan Ford, Radha Rajasingham

Open access · hybridAbstract readSystematic Review
In one paragraph

Synthesis in HIV medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact, top 82% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 citations in OpenAlex.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 4 institutions in 2 countries.

Adrienne E ShapiroDepartments of Global Health & Medicine, University of Washington, Seattle, Washington, USA.
Mark W TenfordeCenters for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
Tom M ChillerCenters for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
Nathan FordDepartment of HIV and Global Hepatitis Programme, World Health Organization, Geneva, Switzerland.
Radha RajasinghamDivision of Infectious Diseases & International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
Centers for Disease Control and Prevention · USUniversity of Minnesota · USUniversity of Washington · USWorld Health Organization · CH

Funding

An Enhanced Package of Care to Reduce Mortality in Persons with Advanced HIV DiseaseR01AI162181 · NIAID · UNIVERSITY OF MINNESOTA · PI RAJASINGHAM, RADHA · 2021 to 2025
$3.2M
Evaluation of CRAG screening with enhanced antifungal therapy for asymptomatic CRAG-positive personsK23AI138851 · NIAID · UNIVERSITY OF MINNESOTA · PI RAJASINGHAM, RADHA · 2018 to 2022
$954k
Novel clinic-based TB diagnostics and testing algorithms for persons with HIVK23AI140918 · NIAID · UNIVERSITY OF WASHINGTON · PI SHAPIRO, ADRIENNE E · 2019 to 2024
$937k
NIAID NIH HHS K23 AI138851NIAID NIH HHS K23 AI140918NIAID NIH HHS R01 AI162181World Health Organization 001
6 · The paper itself

Abstract

backgroundThe purpose of this systematic review is to provide updated evidence on the preferred induction therapy for the treatment of HIV-associated cryptococcal meningitis considering the most recent evidence available in order to inform the need for updates to WHO guidelines.

methodsWe searched Medline via PubMed, EMBASE, the Cochrane Library and clinicaltrials.gov for published or completed randomized clinical trials that evaluated induction treatment of first episode HIV-associated cryptococcal meningitis from 9 July 2018 (date of last search) to 1 September 2021.

resultsOne randomized clinical trial of 844 people with HIV-associated cryptococcal meningitis met the inclusion criteria. Participants were randomized to: (1) amphotericin deoxycholate for 7 days, with flucytosine and fluconazole (control); or (2) a single dose of liposomal amphotericin 10 mg/kg with flucytosine and fluconazole (intervention). In the intention-to-treat analysis, 10-week mortality was 24.8% [95% confidence interval (CI): 20.7-29.3%] in the single-dose liposomal amphotericin group compared with 28.7% (95% CI: 24.4-33.4%) in the control group. The absolute difference in 10-week mortality was -3.9% with an upper one-sided 95% CI of 1.2%, within the 10% pre-specified non-inferiority margin. Fewer participants had grade 3 and 4 adverse events in the intervention arm compared with the control arm (50.0% vs. 62.3%, p < 0.001).

conclusionsIn the single study included in this systematic review, single high-dose liposomal amphotericin B with flucytosine and fluconazole was non-inferior to the WHO-recommended standard of care induction therapy for HIV-associated cryptococcal meningitis, with significantly fewer adverse events.

Indexed as

HIV InfectionsMeningitis, CryptococcalAmphotericin BAntifungal AgentsDrug Therapy, CombinationFluconazoleFlucytosineHumansRandomized Controlled Trials as TopicAmphotericin BAntifungal AgentsFluconazoleFlucytosineliposomal amphotericin BAIDSAIDS-related opportunistic infectionscryptococcal meningitisliposomal amphotericinsystematic review

Identifiers

PMID36123803
PMCPMC10024640
OpenAlexW4296389685

What OpenQuestion holds

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Registered trials

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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.