Evidence map›Paper›PMID 39890234›Full record

ArticleThe Lancet. Global health2025

Causes of HIV-related CNS infection in Cameroon, Malawi, and Tanzania: epidemiological findings from the DREAMM HIV-related CNS implementation study.

Cecilia Kanyama, Charles Kouanfack, Saulos Nyirenda, Sayoki Mfinanga, Sokoine Lesikari Kivuyo, Emma Beaumont, Aude Sturny-Leclère, Sam Phiri, Jonathon Ngoma, Meshack Shimwela and 19 more

Erratum issuedAbstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in The Lancet. Global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
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

5 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
  4. Article
  5. Update on neurological complications of HIV.Current opinion in HIV and AIDS · 2025
    Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

29 authors.

Cecilia KanyamaUniversity of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi.
Charles KouanfackUniversity of Dschang, Dschang, Cameroon.
Saulos NyirendaZomba Central Hospital, Zomba, Malawi.
Sayoki MfinangaNational Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania; Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
Sokoine Lesikari KivuyoNational Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania.
Emma BeaumontDepartment of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK.
Aude Sturny-LeclèreInstitut Pasteur, Université Paris Cité, National Reference Center for Invasive Mycoses, Paris, France; Antifungals, Translational Mycology Research Group, Mycology Department, Paris, France.
Sam PhiriLighthouse Trust, Lilongwe, Malawi.
Jonathon NgomaKamuzu Central Hospital, Lilongwe, Malawi.
Meshack ShimwelaAmana Hospital, Dar es Salaam, Tanzania.
Daniel NkunguMwananyamala Hospital, Dar es Salaam, Tanzania.
Lauriane Nomene FometeYaoundé Central Hospital, Yaoundé, Cameroon.
Rehema SimbaurangaNational Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania.
Chimwemwe ChawingaUniversity of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi.
Nicaine NgakamYaoundé Central Hospital, Yaoundé, Cameroon.
Tom HellerLighthouse Trust, Lilongwe, Malawi.
Sandrine Sa'a LontsiYaoundé Central Hospital, Yaoundé, Cameroon.
Rebecca GathercoleInstitute for Infection and Immunity, City St George's University of London, London, UK.
Elnara AghakishiyevaInstitute for Infection and Immunity, City St George's University of London, London, UK.
Radha RajasinghamUniversity of Minnesota, Minneapolis, MN, USA.
Mina C HosseinipourUniversity of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi.
John BradleyDepartment of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK.
Shabbar JaffarUCL Institute for Global Health, University College London, London, UK.
Olivier LortholaryUnité de Mycologie Moléculaire, Institut Pasteur, Université de Paris, CNRS, UMR2000, Paris, France; Necker-Enfants Malades Hospital, APHP, IHU Imagine, Paris, France.
Thomas HarrisonInstitute for Infection and Immunity, City St George's University of London, London, UK.
Síle F MolloyInstitute for Infection and Immunity, City St George's University of London, London, UK.
Timothée Boyer-ChammardUnité de Mycologie Moléculaire, Institut Pasteur, Université de Paris, CNRS, UMR2000, Paris, France.
Angela LoyseInstitut Pasteur, Université Paris Cité, National Reference Center for Invasive Mycoses, Paris, France; Institute for Infection and Immunity, City St George's University of London, London, UK; Antifungals, Translational Mycology Research Group, Mycology Department, Paris, France. Electronic address: aloyse@sgul.ac.uk.
DREAMM Consortium

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCNS infections cause approximately a third of HIV-related deaths. The Driving Reduced AIDS-Associated Meningo-encephalitis Mortality DREAMM study aimed to prospectively diagnose the aetiology of HIV-related CNS infection in five public hospitals in Cameroon, Malawi, and Tanzania.

methodsDREAMM was a multicentre, hybrid type-2 implementation science project. Adults (aged ≥18 years) presenting with a first episode of suspected CNS infection, who were HIV seropositive or willing to have an HIV test, were eligible for recruitment. Following implementation of the DREAMM model of care, we measured the prevalence of cryptococcal meningitis, tuberculous meningitis, bacterial meningitis, and cerebral toxoplasmosis and did a χ

findingsOf 356 participants with suspected CNS infection analysed at baseline, 269 (76%) were diagnosed as having a CNS infection. Of these, 202 (75%) had a confirmed diagnosis. Between Cameroon, Malawi, and Tanzania, the prevalence of the four main types of CNS infection differed (cryptococcal meningitis p=0·0014, bacterial meningitis p=0·0043, CNS tuberculosis p<0·0001, and toxoplasmosis p<0·0001). Cryptococcal meningitis (148 [55%] of 269) was the leading cause overall. The next most common causes were CNS tuberculosis in Tanzania (29 [29%] of 99) and bacterial meningitis in Malawi (15 [19%] of 80). In Cameroon, cerebral toxoplasmosis (39 [43%] of 90) was the leading cause followed by cryptococcal meningitis (36 [40%] of 90). For cryptococcal meningitis, all-cause 2-week mortality was 23% (34 of 147) and all-cause 10-week mortality was 45% (66 of 146).

interpretationWithin the study population, the aetiology of HIV-related CNS infection varied substantially between Malawi, Cameroon, and Tanzania. Additional prospective epidemiological data are needed to inform HIV programmes. 2-week cryptococcal meningitis mortality outcomes were similar to those of clinical trials. However, new interventions are urgently needed to sustain mortality reductions following hospital discharge.

fundingEuropean and Developing Countries Clinical Trials Partnership and French Agency for Research on AIDS and Viral Hepatitis. TRANSLATIONS: For the French and Portuguese translations of the abstract see Supplementary Materials section.

Indexed as

AIDS-Related Opportunistic InfectionsCentral Nervous System InfectionsHIV InfectionsAdolescentAdultCameroonFemaleHumansMalawiMaleMeningitis, CryptococcalMiddle AgedPrevalenceProspective StudiesTanzaniaToxoplasmosis, Cerebral

Identifiers

PMID39890234

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.