Discontinuation of maintenance therapy for cryptococcal meningitis in patients with AIDS treated with highly active antiretroviral therapy: an international observational study

Andrea De Luca, C Mussini, P Pezzotti, Jm Miró, E Martinez, Jclb De Quiros, P Cinque, V Borghi, A Bedini, P Domingo, P Cahn, P Bossi, A D'Arminio Monforte, M Nelson, N Nwokolo, S Helou, R Negroni, G Jacchetti, S Antinori, A LazzarinA Cossarizza, R Esposito, A Antinori, Ja Aberg

Risultato della ricerca: Contributo in rivistaArticolo in rivista

101 Citazioni (Scopus)

Abstract

We conducted a retrospective, multicenter study evaluating the safety of discontinuing maintenance therapy for cryptococcal meningitis after immune reconstitution. Inclusion criteria were a previous definitive diagnosis of cryptococcal meningitis, a CD4 cell count of >100 cells/microL while receiving highly active antiretroviral therapy (HAART), and the subsequent discontinuation of maintenance therapy for cryptococcal meningitis. The primary end point was relapse of cryptococcal disease. As of July 2002, 100 patients were enrolled. When maintenance therapy was discontinued, the median CD4 cell count was 259 cells/microL and the median plasma virus load was <2.30 log10 copies/mL, and serum cryptococcal antigen was undetectable in 56 patients. During a median follow-up period of 28.4 months (range, 6.7-64.5; 262 person-years), 4 events were observed (incidence, 1.53 events per 100 person-years; 95% confidence interval, 0.42-3.92). Three of these patients had a CD4 cell count of >100 cells/microL and a positive serum cryptococcal antigen test result during the recurrent episode. In conclusion, discontinuation of maintenance therapy for cryptococcal meningitis is safe if the CD4 cell count increases to >100 cells/microL while receiving HAART. Recurrent cryptococcal infection should be suspected in patients whose serum cryptococcal antigen test results revert back to positive after discontinuation of maintenance therapy.
Lingua originaleEnglish
pagine (da-a)565-571
Numero di pagine7
RivistaClinical Infectious Diseases
Volume38
DOI
Stato di pubblicazionePubblicato - 2004

Keywords

  • AIDS-Related Opportunistic Infections
  • Acquired Immunodeficiency Syndrome
  • Adolescent
  • Adult
  • Anti-HIV Agents
  • Antigens, Fungal
  • Antiretroviral Therapy, Highly Active
  • CD4 Lymphocyte Count
  • Female
  • Humans
  • Male
  • Meningitis, Cryptococcal
  • Middle Aged
  • Retrospective Studies
  • Viral Load

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