PMID- 21808432
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20111110
LR  - 20220409
IS  - 2589-0565 (Electronic)
IS  - 2589-0557 (Print)
IS  - 2589-0557 (Linking)
VI  - 31
IP  - 1
DP  - 2010 Jan
TI  - Management of cryptococcal meningitis in HIV-infected patients: Experience from 
      western India.
PG  - 22-6
LID - 10.4103/0253-7184.68996 [doi]
AB  - INTRODUCTION: Cryptococcal meningitis is one of the acquired immunodeficiency 
      syndrome defining infections with high mortality. Amphotericin B is the preferred 
      drug for induction therapy. Despite advances in human immunodeficiency virus 
      (HIV) treatment, Antiretroviral Treatment (ART) roll-out programs and 
      availability of amphotericin B, cryptococcal meningitis remains an important 
      cause of mortality in the African and other developing countries. MATERIALS AND 
      METHODS: We carried out a prospective observational study to determine the 
      treatment response rate, tolerability and outcome of patients with cryptococcal 
      meningitis in HIV treated with amphotericin B. Descriptive statistic was used to 
      analyze the data. RESULTS: A total of 27 patients were diagnosed with 
      cryptococcal meningitis during the study period. Headache (96.29%) was the single 
      most common presenting symptom of cryptococcal meningitis in HIV-infected 
      patients, followed by vomiting (77.77%) and fever (66.66%). Cerebrospinal fluid 
      (CSF) routine and microscopic examination was within normal limits in six 
      patients. CSF became sterile on the 12th day of Amphotericin B in 55.55% of the 
      patients while 33.33% had positive CSF cultures. Patients were started with ART 
      after achieving sterile CSF and tolerated at least 2 weeks of fluconazole 
      consolidation treatment and were free from symptoms. Median time for 
      antiretroviral treatment initiation was 35 (14-90) days after completion of 
      Amphotericin B treatment. One patient developed immune reconstitution 
      inflammatory syndrome (IRIS) after ART. CONCLUSIONS: We found that the 
      recommended 2 weeks induction treatment with Amphotericin B monotherapy for HIV 
      patients with cryptococcal meningitis in resource-limited settings may be 
      suboptimal for at least one-third of the patients. Extending the therapy to 3 
      weeks is likely to result in sterilization of the CSF in a majority of these 
      patients. This finding requires confirmation by a larger sample size in 
      appropriately powered studies. Delaying ART initiation by at least 2 weeks after 
      amphotericin B treatment may decrease the incidence of IRIS.
FAU - Patel, Atul K
AU  - Patel AK
AD  - Infectious Diseases Consultant, Infectious Diseases Clinic, Adit Molecular 
      Diagnostics, "Vedanta" Institute of Medical Sciences, Navarangpura, Ahmedabad - 
      380 009, India.
FAU - Patel, Ketan K
AU  - Patel KK
FAU - Ranjan, Rajiv
AU  - Ranjan R
FAU - Shah, Shalin
AU  - Shah S
FAU - Patel, Jagdish K
AU  - Patel JK
LA  - eng
PT  - Journal Article
PL  - India
TA  - Indian J Sex Transm Dis AIDS
JT  - Indian journal of sexually transmitted diseases and AIDS
JID - 101730896
PMC - PMC3140144
OTO - NOTNLM
OT  - Amphotericin B
OT  - HIV
OT  - cryptococcal meningitis
COIS- Conflict of Interest: None declared
EDAT- 2010/01/01 00:00
MHDA- 2010/01/01 00:01
PMCR- 2010/01/01
CRDT- 2011/08/03 06:00
PHST- 2011/08/03 06:00 [entrez]
PHST- 2010/01/01 00:00 [pubmed]
PHST- 2010/01/01 00:01 [medline]
PHST- 2010/01/01 00:00 [pmc-release]
AID - IJSTD-31-22 [pii]
AID - 10.4103/0253-7184.68996 [doi]
PST - ppublish
SO  - Indian J Sex Transm Dis AIDS. 2010 Jan;31(1):22-6. doi: 10.4103/0253-7184.68996.