Poor long-term outcomes for cryptococcal meningitis in rural South Africa

• DOI: 10.7196/samj.4378
• Publication Date: 2016-04-08T15:53:55Z
• Authors: Richard J Lessells; Portia C Mutevedzi; Tom Heller; Marie-Louise Newell
• Keywords: Adult; Male; Rural Population; 0303 health sciences; Antifungal Agents; HIV Infections; Meningitis, Cryptococcal; Prognosis; 3. Good health; South Africa; 03 medical and health sciences; Treatment Outcome; Amphotericin B; Humans; Female; Fluconazole

To explore linkage to and retention in HIV care after an episode of cryptococcal meningitis (CM) in rural South Africa. Design. A retrospective case series of adult individuals (> or = 16 years old) with laboratory-confirmed CM from January - December 2007 at Hlabisa Hospital--a district hospital in northern KwaZulu-Natal.Inpatient mortality and associated risk factors were analysed. The proportion alive and on antiretroviral therapy (ART) at 2 years was determined by linkage to the HIV treatment programme.One hundred and four individuals were identified with laboratory diagnosis of CM; 74/104 (71.2%) with complete records were included in the analysis. Inpatient mortality was high (40.5%) and was significantly associated with reduced conscious level (aHR 3.09, 95% CI 1.30 - 7.33) and absence of headache (aHR 0.33 for headache, 95% CI 0.13 - 0.87). Only 8 individuals (10.8% of all study subjects) were alive and receiving ART 2 years after the CM episode.Long-term outcomes of CM are poor in routine practice. Interventions to strengthen linkage to HIV treatment and care and continuation of secondary fluconazole prophylaxis are critical.