Evidence map›Paper›PMID 36883578›Full record

ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2023

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.

Suzanne M Ingle, Jose M Miro, Margaret T May, Lauren E Cain, Christine Schwimmer, Robert Zangerle, Helen Sambatakou, Charles Cazanave, Peter Reiss, Vanessa Brandes and 24 more

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 2 pooled it
4.1field-weighted citation impact, top 5% 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

9 citing papers in PubMed, 2 syntheses or guidelines pooled it, 19 citations in OpenAlex.

  1. Pooled it
  2. Guideline
  3. Article
  4. Article
  5. Review
  6. Review
  7. Review
  8. Review
  9. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

34 authors at 20 institutions in 13 countries.

Suzanne M InglePopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
Jose M MiroInfectious Diseases Service Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
Margaret T MayPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
Lauren E CainDepartment of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Christine SchwimmerUniversity of Bordeaux, INSERM, Institut Bergonié, CHU de Bordeaux, CIC-EC 1401, Bordeaux, France.
Robert ZangerleDepartment of Dermatology, Venereology, and Allergy, Medical University Innsbruck, Innsbruck, Austria.
Helen Sambatakou2nd Department of Internal Medicine, HIV Unit, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Charles CazanaveInfectious and Tropical Diseases Department, CHU de Bordeaux, Bordeaux, France.
Peter ReissStichting HIV Monitoring, Amsterdam, The Netherlands.
Vanessa BrandesDepartment I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Cologne, Germany.
Heiner C BucherBasel Institute for Clinical Epidemiology & Biostatistics, Division of Infectious Diseases & Hospital Hygiene, University Hospital Basel, Basel, Switzerland.
Caroline SabinCentre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, United Kingdom.
Francesc VidalInfectious Diseases Unit, Hospital Universitari de Tarragona Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, Spain.
Niels ObelDepartment of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Amanda MocroftCentre of Excellence for Health, Immunity and Infections (CHIP) and PERSIMUNE, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Linda WittkopISPED, INSERM, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France.
Antonella d'Arminio MonforteClinic of Infectious and Tropical Diseases, Department of Health Sciences, University of Milan, San Paolo Hospital, Milan, Italy.
Carlo TortiDepartment of Surgical and Medical Sciences, University "Magna Graecia,", Catanzaro, Italy.
Cristina MussiniInfectious Diseases Unit, University of Modena and Reggio Emilia, Modena, Italy.
Hansjakob FurrerDepartment of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Deborah KonopnickiInfectious Diseases Department, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Ramon TeiraService of Internal Medicine, Hospital Universitario de Sierrallana, Torrelavega, Spain.
Michael S SaagCenter for AIDS Research, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Heidi M CraneDivision of Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA.
Richard D MooreSchool of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Jeffrey M JacobsonCase Western Reserve University, Cleveland, Ohio, USA.
W Chris MathewsDepartment of Medicine, University of California San Diego, San Diego, California, USA.
Elvin GengDivision of Infectious Diseases, Department of Medicine and the Center for Dissemination and Implementation, Institute for Public Health, Washington University in St Louis, St Louis, Missouri, USA.
Joseph J EronDepartment of Medicine, UNC School of Medicine, Chapel Hill, North Carolina, USA.
Keri N AlthoffDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Abigail KrochUniversity of Toronto, Toronto, Ontario, Canada.
Raynell LangDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
M John GillDepartment of Medicine, University of Calgary, Southern Alberta HIV Clinic, Calgary, Alberta, Canada.
Jonathan A C SternePopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
Johns Hopkins University · USUniversity of Bristol · GBInstituto de Salud Carlos III · ESUniversité de Bordeaux · FRCase Western Reserve University · USCentre Hospitalier Universitaire de Bordeaux · FRCopenhagen University Hospital · DKHarvard University · USHospital Sierrallana · ESInnsbruck Medical University · ATMagna Graecia University · ITNational and Kapodistrian University of Athens · GRStichting HIV Monitoring · NLUniversité Libre de Bruxelles · BEUniversity College London · GBUniversity Hospital of Basel · CHUniversity of Alabama at Birmingham · USUniversity of Bern · CHUniversity of Calgary · CAUniversity of California San Diego · US

Funding

WOMEN'S HEALTH AGENDAU01AI038858 · NIAID · SOCIAL AND SCIENTIFIC SYSTEMS, INC. · PI BENSON, CONSTANCE ANN · 1996 to 2008
$157.5M
AIDS Clinical Trials Group NetworkU01AI068636 · NIAID · SOCIAL AND SCIENTIFIC SYSTEMS, INC. · PI KURITZKES, DANIEL R. · 2006 to 2010
$147.1M
UCSF CLINICAL AND TRANSLATIONAL SCIENCE INSTITUTEUL1RR024131 · NCRR · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI JOHNSTON, S. CLAIBORNE · 2006 to 2011
$111.2M
University of Washington/Fred Hutch Center for AIDS ResearchP30AI027757 · NIAID · UNIVERSITY OF WASHINGTON · PI EDWIN ROBERTO ORELLANA · 1988 to 2026
$104.9M
Unsolicited R24 for the CFAR-Network of Integrated Clinical Sciences, CNICSR24AI067039 · NIAID · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI Michael S. Saag · 2006 to 2026
$99.4M
The impact of HIV viral diversity and cellular immunity on HIV pathogenesisP30AI060354 · NIAID · HARVARD UNIVERSITY (MEDICAL SCHOOL) · PI RAJESH T GANDHI · 2004 to 2026
$94.4M
Virology CoreP30AI027763 · NIAID · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI MALLORY O JOHNSON · 1988 to 2026
$93.6M
Virology CoreP30AI027767 · NIAID · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI Latesha Ellen Elopre · 1988 to 2026
$84.1M
VirologyP30AI036214 · NIAID · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI David Mitchell Smith · 1994 to 2026
$78.4M
STATISTICAL AND DATA MANAGEMENT CENTERU01AI038855 · NIAID · HARVARD UNIVERSITY (SCH OF PUBLIC HLTH) · PI HUGHES, MICHAEL DAVID · 1996 to 2006
$78.1M
Engaging University of California Stakeholders for Biorespository ResearchUL1TR000004 · NCATS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI GRANDIS, JENNIFER RUBIN · 2012 to 2015
$78.0M
Studies of Ocular Complications of AIDS - Coordinating CenterU10EY008057 · NEI · JOHNS HOPKINS UNIVERSITY · PI VAN NATTA, MARK L · 1988 to 2012
$78.0M
Department of Health NF-SI-0611-10168Intramural NIH HHS Z01 CP010114Intramural NIH HHS Z01 CP010176Medical Research CouncilNCATS NIH HHS KL2 TR000421NCATS NIH HHS UL1 TR000004NCATS NIH HHS UL1 TR000083NCI NIH HHS N02CP55504NCRR NIH HHS UL1 RR024131NEI NIH HHS K23 EY013707NEI NIH HHS U10 EY008052NEI NIH HHS U10 EY008057NEI NIH HHS U10 EY008067NHLBI NIH HHS U01 HL146192NHLBI NIH HHS U01 HL146193NHLBI NIH HHS U01 HL146194NHLBI NIH HHS U01 HL146201NHLBI NIH HHS U01 HL146202NHLBI NIH HHS U01 HL146203NHLBI NIH HHS U01 HL146204NHLBI NIH HHS U01 HL146205NHLBI NIH HHS U01 HL146208NHLBI NIH HHS U01 HL146240NHLBI NIH HHS U01 HL146241NHLBI NIH HHS U01 HL146242NHLBI NIH HHS U01 HL146245NHLBI NIH HHS U01 HL146333NIAAA NIH HHS R01 AA016893NIAAA NIH HHS U01 AA013566NIAAA NIH HHS U01 AA020790NIAAA NIH HHS U01 AA026209NIAAA NIH HHS U24 AA020794NIAID NIH HHS F31 AI124794NIAID NIH HHS K01 AI093197NIAID NIH HHS K01 AI131895NIAID NIH HHS K24 AI065298NIAID NIH HHS K24 AI118591NIAID NIH HHS P30 AI027757NIAID NIH HHS P30 AI027763NIAID NIH HHS P30 AI027767NIAID NIH HHS P30 AI036214NIAID NIH HHS P30 AI036219NIAID NIH HHS P30 AI050409NIAID NIH HHS P30 AI060354NIAID NIH HHS P30 AI073961NIAID NIH HHS P30 AI094189NIAID NIH HHS P30 AI110527NIAID NIH HHS R24 AI067039NIAID NIH HHS U01 AI038855NIAID NIH HHS U01 AI038858NIAID NIH HHS U01 AI068634NIAID NIH HHS U01 AI068636NIAID NIH HHS U01 AI069432NIAID NIH HHS U01 AI069434NIAID NIH HHS U01 AI069918NIA NIH HHS R01 AG053100NIDA NIH HHS F31 DA037788NIDA NIH HHS K24 DA000432NIDA NIH HHS R01 DA011602NIDA NIH HHS R01 DA012568NIDA NIH HHS U01 DA036935NIMHD NIH HHS G12 MD007583NIMHD NIH HHS U54 MD007587NIMH NIH HHS P30 MH062246
6 · The paper itself

Abstract

backgroundRandomized controlled trials (RCTs) from low- and middle-income settings suggested that early initiation of antiretroviral therapy (ART) leads to higher mortality rates among people with HIV (PWH) who present with cryptococcal meningitis (CM). There is limited information about the impact of ART timing on mortality rates in similar people in high-income settings.

methodsData on ART-naive PWH with CM diagnosed from 1994 to 2012 from Europe/North America were pooled from the COHERE, NA-ACCORD, and CNICS HIV cohort collaborations. Follow-up was considered to span from the date of CM diagnosis to earliest of the following: death, last follow-up, or 6 months. We used marginal structural models to mimic an RCT comparing the effects of early (within 14 days of CM) and late (14-56 days after CM) ART on all-cause mortality, adjusting for potential confounders.

resultsOf 190 participants identified, 33 (17%) died within 6 months. At CM diagnosis, their median age (interquartile range) was 38 (33-44) years; the median CD4+ T-cell count, 19/μL (10-56/μL); and median HIV viral load, 5.3 (4.9-5.6) log10 copies/mL. Most participants (n = 157 [83%]) were male, and 145 (76%) started ART. Mimicking an RCT, with 190 people in each group, there were 13 deaths among participants with an early ART regimen and 20 deaths among those with a late ART regimen. The crude and adjusted hazard ratios comparing late with early ART were 1.28 (95% confidence interval, .64-2.56) and 1.40 (.66-2.95), respectively.

conclusionsWe found little evidence that early ART was associated with higher mortality rates among PWH presenting with CM in high-income settings, although confidence intervals were wide.

Indexed as

HIV InfectionsMeningitis, CryptococcalAdultAnti-Retroviral AgentsCD4 Lymphocyte CountCohort StudiesDeveloped CountriesFemaleHIVHumansMaleAnti-Retroviral AgentsARTcausal inferencecryptococcal meningitisHIV

Identifiers

PMID36883578
PMCPMC10320049
OpenAlexW4323438780

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.