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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Determinants of two-year mortality among hiv positive patients with cryptococcal meningitis initiating standard antifungal treatment with or without adjunctive dexamethasone in uganda
PLoS Neglected Tropical Diseases, Volume 14, No. 11, Article e0008823, Year 2020
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Description
Globally, early initiation of antiretroviral therapy for HIV led to a reduction in the estimated mortality from cryptococcal meningitis (CCM) from 624,700 in 2009 to 181,100 in 2014. However, CCM remains one of the leading causes of mortality among HIV infected patients especially in sub-Saharan Africa where 75% of the deaths occur. Most of the studies evaluating mortality have reported short-term mortality (at or before 10 weeks of therapy). We determined mortality and associated factors among patients treated for CCM in the CryptoDex trial (ISRCTN59144167) in Uganda, and the effect of dexamethasone adjunctive therapy on mortality at two years. We conducted a retrospective cohort study between May 2017 and July 2017 to determine the long term survival (up to 2 years post-randomization) of all patients who had been enrolled into the CryptoDex trial in Uganda. The CryptoDex trial recruited between April 2013 and February 2015. We estimated mortality rates and determined factors affecting mortality at two years using Cox regression. The study followed up 211 participants, 127 (60.2%) of whom were male. Sixteen participants (7.58%) were diagnosed with HIV at the same admission when CCM was diagnosed. By two years following randomization 127 (60%) participants had died, a mortality rate of 67 deaths per 100 person-years. Mortality was associated with Glasgow coma score (GCS) below 15 (adjusted Hazard ratio (aHR) 1.77, 95% CI: 1.02–2.44), p = 0.040; weight (aHR 0.97, per 1 Kg increase; 95% CI: 0.94–0.99), p = 0.003; and presence of convulsions (aHR 2.31, 95% CI: 1.32–4.04), p = 0.004, while dexamethasone use and fungal burden had no effect. Longterm mortality in CCM patients remains high even among patients receiving recommended therapy. Strategies to improve long-term survival in CCM patients are urgently needed, especially targeting those with reduced GCS, low weight, and convulsions. © 2020 Kitonsa et al.
Authors & Co-Authors
Kitonsa, Jonathan
Uganda, Entebbe
Uganda Virus Research Institute
Nsubuga, Rebecca Namugabwe
Uganda, Entebbe
Uganda Virus Research Institute
Mayanja, Yunia
Uganda, Entebbe
Uganda Virus Research Institute
Kiwanuka, Julius P.
Unknown Affiliation
Nikweri, Yofesi
Uganda, Entebbe
Uganda Virus Research Institute
Onyango, Martin
Uganda, Entebbe
Uganda Virus Research Institute
Anywaine, Zacchaeus
Uganda, Entebbe
Uganda Virus Research Institute
Ggayi, Abu Baker M.
Uganda, Entebbe
Uganda Virus Research Institute
Kibengo, Freddie Mukasa
Uganda, Entebbe
Uganda Virus Research Institute
Kaleebu, Pontiano P.
Uganda, Entebbe
Uganda Virus Research Institute
Day, Jeremy N.
Viet Nam, Ho Chi Minh City
Oxford University Clinical Research Unit
United Kingdom, Oxford
Nuffield Department of Medicine
Statistics
Citations: 3
Authors: 11
Affiliations: 3
Identifiers
Doi:
10.1371/journal.pntd.0008823
ISSN:
19352727
Research Areas
Environmental
Infectious Diseases
Study Design
Randomised Control Trial
Cohort Study
Study Approach
Quantitative
Study Locations
Uganda
Participants Gender
Male