AIDS-associated cryptococcosis: a comparison of epidemiology, clinical features and outcome in the pre- and post-HAART eras. Experience of a single centre in Italy

HIV Med. 2009 Jan;10(1):6-11. doi: 10.1111/j.1468-1293.2008.00645.x.


Objectives To assess the prevalence, clinical and immunological characteristics, risk factors and survival of patients with AIDS-related cryptococcosis in the era of highly active antiretroviral therapy (HAART). Methods All newly diagnosed cryptococcosis cases identified retrospectively from among a series of AIDS patients hospitalized consecutively at a single institution in Italy in 1985-1996 (pre-HAART period, n=165) and 1997-2006 (post-HAART period, n=40) were analysed comparatively. Results The prevalence of cryptococcosis decreased from 4.7% (165/3543) to 2.2% (40/1805) between the pre- and post-HAART periods (P=0.0001). There were no differences in the clinical features or immunological status of the patients between the two cohorts. The variables associated with the occurrence of cryptococcosis in the post-HAART era were older age (P<0.001), no previous diagnosis of HIV infection (P<0.001) and infection in homosexual males (P=0.004). During the post-HAART period, immune reconstitution inflammatory syndrome associated with cryptococcosis was observed in five patients (19.3%) a median of 15 weeks after the start of HAART. Thirty-day survival (P=0.045) and overall survival (P=0.0001) were significantly better among patients diagnosed with cryptococcosis in the post-HAART compared to those diagnosed in the pre-HAART era. Conclusions The AIDS-associated cryptococcosis observed in Western countries in the HAART era has similar clinical and immunological characteristics to that observed in the pre-HAART era, but a significantly better outcome.

Publication types

  • Comparative Study

MeSH terms

  • AIDS-Related Opportunistic Infections / complications*
  • AIDS-Related Opportunistic Infections / drug therapy
  • AIDS-Related Opportunistic Infections / epidemiology
  • Adult
  • Aged
  • Antifungal Agents / therapeutic use
  • Antiretroviral Therapy, Highly Active*
  • CD4 Lymphocyte Count
  • Cryptococcosis / drug therapy
  • Cryptococcosis / epidemiology
  • Cryptococcosis / etiology*
  • Female
  • HIV-1*
  • Hospitalization
  • Humans
  • Italy / epidemiology
  • Male
  • Middle Aged
  • Retrospective Studies
  • Survival Analysis
  • Viral Load
  • Young Adult


  • Antifungal Agents