PMID- 34154509
OWN - NLM
STAT- MEDLINE
DCOM- 20211005
LR  - 20220531
IS  - 1744-7666 (Electronic)
IS  - 1465-6566 (Linking)
VI  - 22
IP  - 15
DP  - 2021 Oct
TI  - Strategies for the diagnosis and management of meningitis in HIV-infected adults 
      in resource limited settings.
PG  - 2053-2070
LID - 10.1080/14656566.2021.1940954 [doi]
AB  - INTRODUCTION: The incidence of human immunodeficiency virus-1 (HIV-1) associated 
      meningitis has been declining in the post-combination antiretroviral treatment 
      (ART) era, although survival rates remain low for the common causes like 
      tuberculosis and cryptococcal disease. Diagnosis and treatment of meningitis in 
      HIV-1 is complicated by atypical clinical presentations, limited accuracy of 
      diagnostic tests, access to diagnostic tests, and therapeutic agents in low- and 
      middle-income countries (LMIC) and immune reconstitution inflammatory syndrome 
      (IRIS). AREAS COVERED: We provide an overview of the common etiologies of 
      meningitis in HIV-1-infected adults, suggest a diagnostic approach based on 
      readily available tests, and review specific chemotherapeutic agents, 
      host-directed therapies, supportive care, timing of ART initiation, and 
      considerations in the management of IRIS with a focus on resource-limited 
      settings. They identify key knowledge gaps and suggest areas for future research. 
      EXPERT OPINION: Evidence-based management of HIV-1-associated meningitis is 
      sparse for common etiologies. More readily available and sensitive diagnostic 
      tests as well as standardized investigation strategies are required in LMIC. 
      There is a lack of availability of recommended drugs in areas of high HIV-1 
      prevalence and a limited pipeline of novel chemotherapeutic agents. Host-directed 
      therapies have been inadequately studied.
FAU - Bremer, Marise
AU  - Bremer M
AD  - Wellcome Centre for Infectious Disease Research in Africa, Institute of 
      Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory.
FAU - Kadernani, Yakub E
AU  - Kadernani YE
AD  - Wellcome Centre for Infectious Disease Research in Africa, Institute of 
      Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory.
FAU - Wasserman, Sean
AU  - Wasserman S
AD  - Wellcome Centre for Infectious Disease Research in Africa, Institute of 
      Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory.
AD  - Department of Medicine, University of Cape Town, Groote Schuur Hospital, 
      Observatory, Republic of South Africa.
FAU - Wilkinson, Robert J
AU  - Wilkinson RJ
AD  - Wellcome Centre for Infectious Disease Research in Africa, Institute of 
      Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory.
AD  - Department of Medicine, University of Cape Town, Groote Schuur Hospital, 
      Observatory, Republic of South Africa.
AD  - Department of Infectious Diseases, Imperial College London, London, UK.
AD  - Francis Crick Institute, London, UK.
AD  - Faculty of Life Sciences, University College London, London, UK.
FAU - Davis, Angharad G
AU  - Davis AG
AD  - Wellcome Centre for Infectious Disease Research in Africa, Institute of 
      Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory.
AD  - Francis Crick Institute, London, UK.
AD  - Faculty of Life Sciences, University College London, London, UK.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20210621
PL  - England
TA  - Expert Opin Pharmacother
JT  - Expert opinion on pharmacotherapy
JID - 100897346
RN  - 0 (Antifungal Agents)
RN  - 8VZV102JFY (Fluconazole)
SB  - IM
MH  - *AIDS-Related Opportunistic Infections/drug therapy
MH  - Adult
MH  - Antifungal Agents/therapeutic use
MH  - Fluconazole
MH  - *HIV Infections/complications/diagnosis/drug therapy
MH  - Humans
MH  - *Meningitis, Cryptococcal/diagnosis/drug therapy
OTO - NOTNLM
OT  - HIV
OT  - IRIS
OT  - Meningitis
OT  - cryptococcal
OT  - opportunistic infection
OT  - tuberculosis
EDAT- 2021/06/23 06:00
MHDA- 2021/10/06 06:00
CRDT- 2021/06/22 05:33
PHST- 2021/06/23 06:00 [pubmed]
PHST- 2021/10/06 06:00 [medline]
PHST- 2021/06/22 05:33 [entrez]
AID - 10.1080/14656566.2021.1940954 [doi]
PST - ppublish
SO  - Expert Opin Pharmacother. 2021 Oct;22(15):2053-2070. doi: 
      10.1080/14656566.2021.1940954. Epub 2021 Jun 21.