Evidence map›Paper›PMID 39928682›Full record

ArticlePLoS neglected tropical diseases2025

Impact of cerebrospinal fluid leukocyte infiltration and activated neuroimmune mediators on survival with HIV-associated cryptococcal meningitis.

Samuel Okurut, David R Boulware, Yukari C Manabe, Lillian Tugume, Caleb P Skipper, Kenneth Ssebambulidde, Joshua Rhein, Abdu K Musubire, Andrew Akampurira, Elizabeth C Okafor and 4 more

Abstract read
In one paragraph

Article in PLoS neglected tropical diseases, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. 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. Review
  4. Article
  5. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors.

Samuel OkurutResearch Department, Infectious Diseases Institute, Makerere University, Kampala, Uganda.ORCID https://orcid.org/0000-0002-9292-8687
David R BoulwareDivision of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America.
Yukari C ManabeResearch Department, Infectious Diseases Institute, Makerere University, Kampala, Uganda.
Lillian TugumeResearch Department, Infectious Diseases Institute, Makerere University, Kampala, Uganda.
Caleb P SkipperDivision of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America.
Kenneth SsebambuliddeResearch Department, Infectious Diseases Institute, Makerere University, Kampala, Uganda.
Joshua RheinDivision of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America.
Abdu K MusubireResearch Department, Infectious Diseases Institute, Makerere University, Kampala, Uganda.
Andrew AkampuriraResearch Department, Infectious Diseases Institute, Makerere University, Kampala, Uganda.
Elizabeth C OkaforDivision of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America.
Joseph O OloboDepartment of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.
Edward N JanoffMucosal and Vaccine Research Program Colorado, Department of Medicine, Division of Infectious Diseases, University of Colorado Denver, Aurora, Colorado, United States of America.
David B MeyaResearch Department, Infectious Diseases Institute, Makerere University, Kampala, Uganda.
for ASTRO Trial Team

Funding

NPGH LEADERs YR12: OBSSR (Greenberg, Ngwafong Mukere) & NIBIB (Lee)D43TW009345 · FIC · UNIVERSITY OF WASHINGTON · PI Dibyadyuti Datta, Chandy C. John · 2017 to 2026
$15.2M
Improving Diagnostics and Neurocognitive Outcomes in HIV/AIDS-related MeningitisR01NS086312 · NINDS · UNIVERSITY OF MINNESOTA · PI David R Boulware, David Bisagaya Meya · 2013 to 2026
$8.3M
Infectious Disease Training in Clinical InvestigationT32AI055433 · NIAID · UNIVERSITY OF MINNESOTA TWIN CITIES · PI David R Boulware · 2003 to 2026
$6.1M
Northern/Pacific Universities Global Health Research Training ConsortiumR25TW009345 · FIC · UNIVERSITY OF WASHINGTON · PI KOLARS, JOSEPH C., NERURKAR, VIVEK RAMCHANDRA · 2012 to 2016
$5.9M
TB Meningitis: Evaluating CSF Immunology to Discover Hidden Disease and Potential Immunomodulatory TherapiesR01AI162786 · NIAID · UNIVERSITY OF MINNESOTA · PI BOULWARE, DAVID R, MEYA, DAVID BISAGAYA · 2021 to 2025
$3.3M
HIV Co-infections in Uganda: TB, Cryptococcus, and Viral Hepatitis.D43TW009771 · FIC · JOHNS HOPKINS UNIVERSITY · PI CASTELNUOVO, BARBARA, KAMBUGU, ANDREW DDUNGU · 2014 to 2023
$3.3M
Mechanisms of Impaired HIV-associated B cell and Pneumococcal Vaccine responsesR01AI108479 · NIAID · UNIVERSITY OF COLORADO DENVER · PI JANOFF, EDWARD N · 2014 to 2018
$2.3M
Outcomes of Cryptococcal Meningitis in UgandaK24AI096925 · NIAID · UNIVERSITY OF MINNESOTA · PI BOHJANEN, PAUL R · 2011 to 2015
$1.0M
Improving Outcomes of HIV-Associated Cryptococcosis in Resource-Limited SettingsK01TW010268 · FIC · UNIVERSITY OF MINNESOTA · PI RHEIN, JOSHUA R · 2016 to 2020
$703k
Midcareer Mentoring for Clinical Research in HIV/AIDS-related cryptococcal and TB meningitisK24AI184270 · NIAID · UNIVERSITY OF MINNESOTA · PI David R Boulware · 2024 to 2026
$648k
The immunopathogenesis of HIV-related Immune Reconstitution Inflammatory SyndromeR01AI078934 · NIAID · INFECTIOUS DISEASES INSTITUTE · PI KAMBUGU, ANDREW DDUNGU, MEYA, DAVID BISAGAYA · 2010 to 2013
$415k
Impact of HIV and HIV therapy on the Etiology and Outcome of Meningitis in UgandaR21NS065713 · NINDS · UNIVERSITY OF MINNESOTA · PI BOHJANEN, PAUL R, BOULWARE, DAVID R · 2010 to 2011
$276k
CSRD VA I01 CX001464FIC NIH HHS D43 TW009345FIC NIH HHS D43 TW009771FIC NIH HHS K01 TW010268FIC NIH HHS R25 TW009345NIAID NIH HHS K24 AI096925NIAID NIH HHS K24 AI184270NIAID NIH HHS R01 AI078934NIAID NIH HHS R01 AI108479NIAID NIH HHS R01 AI162786NIAID NIH HHS T32 AI055433NINDS NIH HHS R01 NS086312NINDS NIH HHS R21 NS065713Wellcome Trust
6 · The paper itself

Abstract

introductionCryptococcal meningitis remains a prominent cause of death in persons with advanced HIV disease. CSF leukocyte infiltration predicts survival at 18 weeks; however, how CSF immune response relates to CSF leukocyte infiltration is unknown.

methodsWe enrolled 401 adults with HIV-associated cryptococcal meningitis in Uganda who received amphotericin and fluconazole induction therapy. We assessed the association of CSF leukocytes, chemokine, and cytokine responses with 18-week survival.

resultsParticipants with CSF leukocytes ≥50/microliter had a higher probability of 18-week survival compared with those with ≤50 cells/microliter (68% (52/77 vs. 52% (151/292); Hazard Ratio = 1.63, 95% confidence interval 1.14-2.23; p = 0.008). Survival was also associated with higher expression of T helper (Th)-1, Th17 cytokines, and immune regulatory elements. CSF levels of Programmed Death-1 Ligand, CXCL10, and Interleukin (IL)-2 independently predicted survival. In multivariate analysis, CSF leukocytes were inversely associated with CSF fungal burden and positively associated with CSF protein and immune parameters (interferon-gamma (IFN-γ), IL-17A, tumor necrosis factor alpha (TNF)-α, and circulating CD4+ and CD8+ T cells).

conclusion18-week survival after diagnosis of cryptococcal meningitis was associated with higher CSF leukocytes at baseline with greater T helper 1 (IFN-γ, IL-2 and TNF-α cytokines), T helper 17 (IL-17A cytokine) and CXCR3+ T cell (CXCL10 chemokine) responses. These results highlight the interdependent contribution of soluble and cellular immune responses in predicting survival and may support potential pathways for adjunctive immune therapy in HIV-associated cryptococcal meningitis.

Indexed as

Cerebrospinal FluidHIV InfectionsLeukocytesMeningitis, CryptococcalAdultAntifungal AgentsCytokinesFemaleFluconazoleHumansMaleMiddle AgedSurvival AnalysisUgandaYoung AdultAntifungal AgentsCytokinesFluconazole

Identifiers

PMID39928682
PMCPMC11844869

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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.