Touma M, et al. – Researchers here aimed at describing the incidence, clinical presentation, and outcome of cryptococcal meningitis (CM) in HIV–infected individuals during the highly active antiretroviral therapy (HAART) era. Findings revealed a substantial decrease in the incidence of HIV–associated CM after the introduction of HAART. Early HIV diagnosis and HAART initiation seemed warranted to further decrease CM incidence and associated mortality.

Methods

• Researchers used a nationwide, population-based cohort of HIV-infected individuals to estimate incidence and mortality of CM including risk factors.
• This study included a description of neurological symptoms of CM at presentation and follow-up in the study period 1995–2014.

Results

• 40 of 6,351 HIV-infected individuals were diagnosed with CM.
• Findings revealed the incidence rates of 3.7, 1.8, and 0.3 per 1000 person-years at risk in 1995–1996, 1997–1999, and 2000–2014, respectively.
• Decreased risk of acquiring CM was observed with initiation of HAART [incidence rate ratio (IRR), 0.1 (95% CI, 0.05–0.22)].
• Increased risk of CM was observed in African origin individuals [IRR, 2.05 (95% CI, 1.00–4.20)].
• Headache, cognitive deficits, fever, neck stiffness, nausea, and vomiting were identified as the main signs and symptoms at presentation.
• All individuals diagnosed with CM indicated a CD4+ cell count <200 cells/μl [median 26; interquartile range (IQR), 10–50)].
• Overall, high mortality following CM was observed and there appeared no marked change in mortality in the first 4 months over time.
• However, individuals who survived generally indicated a favorable prognosis, with 86% (18/21) returning to the pre-CM level of activity.