Cryptococcal infection in the era of anti-retroviral therapy (ART) amomg HIV infected patients with meningitis at a tertiary hospital in a low - resource setting.

Abstract

Background: Despite improved access to anti-retroviral therapy (ART) in Africa, HIV-associated cryptococcal meningitis (CM) appears to remain a cause of substantial morbidity and mortality in sub-Saharan African. This study determined the prevalence, associated factors and outcomes of CM among HIV positive meningitis patients at a tertiary hospital in Zimbabwe. Methods: Eligible HIV positive patients admitted with clinical features of meningitis were recruited into the study. CM was diagnosed on the basis of a positive cerebrospinal fluid (CSF) culture for cryptococcus species, a positive CSF cryptococcal antigen test (CRAG) or a positive CSF India ink test. Patients’ demographic information, clinical features and laboratory test values were recorded. Results: One hundred and forty-four participants were enrolled into the study. CM was diagnosed in 41% (59/144). Of the patients with CM, slightly more than half [54.2% (32/59)] were on ART and 53% (17/32) had initiated ART within one year prior to the diagnosis of CM. Median current CD4 counts were significantly lower among CM patients [32 .0(IQR 10.5 – 64.0)] compared to non-CM patients [158.0(IQR: 47.0–324.0)] (p<0.001). In-hospital mortality associated with CM was 45%. Conclusions: The proportion of cryptococcal meningitis cases and the associated in-hospital mortality were very high in the study. This suggests that cryptococcal disease burden is still significantly high despite improved access to ART. Expansion of prevention strategies, such as screening for asymptomatic cryptococcal infection among patients with low CD4 count (less than 200), has the potential to improve the morbidity and mortality associated with cryptococcal meningitis.