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Factors associated with early mycological clearance in HIV-associated cryptococcal meningitis

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dc.contributor.author Concha-Velasco, Fatima
dc.contributor.author Gonzalez-Lagos, Elsa
dc.contributor.author Seas, Carlos
dc.contributor.author Bustamante, Beatriz
dc.date.accessioned 2019-01-25T15:18:35Z
dc.date.available 2019-01-25T15:18:35Z
dc.date.issued 2017
dc.identifier.uri https://hdl.handle.net/20.500.12866/4652
dc.description.abstract Introduction: The first-line combination therapy for HIV-associated cryptococcal meningitis (CM), a condition of high mortality particularly in the first two weeks of treatment, consists of amphotericin B plus flucytosine (5-FC). Given that 5-FC remains unavailable in many countries, the knowledge of factors influencing mycological clearance in patients treated with second-line therapy could contribute to effective management. Objectives: To determine the factors associated with the clearance of Cryptococcus sp. from the cerebrospinal fluid by the second week of effective antifungal therapy (early mycological clearance) in HIV-associated CM. Methods: Retrospective cohort study based on secondary data corresponding to HIV-associated CM cases hospitalized at a tertiary health care center in Lima, Peru where 5-FC remains unavailable. Risk factors associated with early mycological clearance were analyzed by generalized linear regression models. Results: From January 2000 to December 2013, 234 individuals were discharged with a diagnosis of HIV-associated CM; in 215 we retrieved the required data. The inpatient mortality was 20% (43/215), 15 of them in the first two weeks of treatment. In the final model (157 cases), adjusted for age, previous episode of CM, ART use, type of antifungal treatment, raised intracranial pressure, frequency of therapeutic lumbar punctures, baseline fungal burden and treatment period, the factors associated with early mycological clearance were: Amphotericin B deoxycholate plus fluconazole as combination therapy (RR, 1.56; 95% CI, 1.14–2.14); severe baseline intracranial pressure (≥35 cm H2O) (RR, 0.57; 95% CI, 0.33–0.99); and baseline fungal burden over 4.5 log10 CFU/mL (RR, 0.61 95% CI: 0.39–0.95). Conclusions: In a setting without access to first-line therapy for CM, the combination therapy with amphotericin B deoxycholate plus fluconazole was positively associated with early mycological clearance, while high fungal burden and severe baseline intracranial pressure were negatively associated, and thus related to failure. en_US
dc.language.iso eng
dc.publisher PLoS
dc.relation.ispartof urn:issn:1932-6203
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Adult en_US
dc.subject Female en_US
dc.subject Humans en_US
dc.subject Male en_US
dc.subject Retrospective Studies en_US
dc.subject Treatment Outcome en_US
dc.subject Risk Factors en_US
dc.subject Drug Therapy, Combination en_US
dc.subject Immunocompromised Host en_US
dc.subject AIDS-Related Opportunistic Infections/drug therapy/immunology/microbiology en_US
dc.subject Amphotericin B/therapeutic use en_US
dc.subject Antifungal Agents/therapeutic use en_US
dc.subject Colony Count, Microbial en_US
dc.subject Deoxycholic Acid/therapeutic use en_US
dc.subject Drug Combinations en_US
dc.subject Fluconazole/therapeutic use en_US
dc.subject HIV Infections/drug therapy/immunology/microbiology en_US
dc.subject Meningitis, Cryptococcal/drug therapy/immunology/microbiology en_US
dc.title Factors associated with early mycological clearance in HIV-associated cryptococcal meningitis en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1371/journal.pone.0174459
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.00 es_PE
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.02
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.08
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.01.055

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