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Review
. 2017 Apr;15(4):331-340.
doi: 10.1080/14787210.2017.1285697. Epub 2017 Feb 9.

Recent Advances in AIDS-related Cryptococcal Meningitis Treatment With an Emphasis on Resource Limited Settings

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Free PMC article
Review

Recent Advances in AIDS-related Cryptococcal Meningitis Treatment With an Emphasis on Resource Limited Settings

Sarah Lofgren et al. Expert Rev Anti Infect Ther. .
Free PMC article

Abstract

Recent advances in the treatment and prevention of cryptococcal meningitis have the potential to decrease AIDS-related deaths. Areas covered: Targeted screening for asymptomatic cryptococcal antigenemia in persons with AIDS is a cost effective method for reducing early mortality in patients on antiretroviral therapy. For persons with symptomatic cryptococcal meningitis, optimal initial management with amphotericin and flucytosine improves survival compared to alternative therapies; however, amphotsericin is difficult to administer and flucytosine has not been available in middle or low income countries, where cryptococcal meningitis is most prevalent. Expert commentary: Improved care for cryptococcal meningitis patients in resource-limited settings is possible, and new treatment possibilities are emerging.

Keywords: AIDS; CM-IRIS; HIV; antifungal therapy; antiretroviral therapy; cryptococcal meningitis; immune reconstitution inflammatory syndrome; review; sertraline.

Conflict of interest statement

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Figures

Figure 1
Figure 1. Rate of CSF Cryptococcus culture clearance for induction antifungal regimens
Figure 1 displays the early fungicidal activity (EFA) of induction regimens for the treatment for cryptococcal meningitis, measured as log10 clearance of Cryptococcus yeasts per mL of CSF per day using quantitative CSF cultures and calculated via linear regression. Values are the means with 95% confidence intervals as pooled from Table 2. Abbreviation: AmB, amphotericin; fluc, fluconazole; CFU, colony forming units; CSF, cerebrospinal fluid.
Figure 2
Figure 2. Rate of CSF Cryptococcus Clearance by Sertraline Dose
Figure 2 displays the CSF early fungicidal activity when receiving increases doses of sertraline coupled with a background regimen of amphotericin B deoxycholate and fluconazole 800 mg/day. EFA is estimated by simple linear regression or by a mixed effects regression model (54). The comparison historical controls were from the same study site in Uganda during the Cryptococcal Optimal ART Timing (COAT) trial who also received amphotericin B and fluconazole 800 mg/day (P=0.04) (50).
Figure 3
Figure 3. Survival after Therapeutic Lumbar Puncture or No Therapeutic Lumbar Puncture
Figure 3 displays the survival curves of those receiving a therapeutic lumbar puncture in the first 10 days of therapy (median 2 days after diagnosis) versus no therapeutic lumbar puncture, as reported by Rolfes et al. (64)

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