HIV: late mortality from cryptococcosis remains a concern

  • Hevey MA & al.
  • J Acquir Immune Defic Syndr
  • 1 Sep 2019

  • International Clinical Digest
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Takeaway

  • The late mortality rate from cryptococcosis remains ~50% among people living with HIV (PLWH).
  • Mortality is higher among individuals who are not virologically suppressed, and those with surrogate markers for low socioeconomic status.

Why this matters

  • Mortality risk remains high >90 days postcryptococcal infection diagnosis.
  • Close follow-up, efforts to address virological suppression may help improve outcomes.

Key results

  • 105 PLWH with cryptococcosis.
  • Overall mortality was 47.6% (n=50) over a median follow-up of 3.7 (interquartile range [IQR], 1.1-8.1) years.
  • Median postcryptococcosis diagnosis survival was 244 (IQR, 43-1167) days.
  • Mortality was higher among individuals diagnosed before the advent of modern antiretroviral therapy (ART: HR, 2.2; 95% CI, 1.2-4.3; P=.014).
  • Late mortality was higher among individuals diagnosed before the modern ART era (48% vs 12%, P<.001>
  • Late mortality (97%, n=32) was associated with HIV+ status at diagnosis (P=.003 vs survivors), lower rates of viral suppression (P=.001 vs survivors), and government insurance (88%, n=29; P=.008 vs survivors).
  • Logistic regression: HIV viral load suppressed at last observation (P=.033), insurance provider (P=.042), ART treatment era (P=.002) remained significantly associated with late mortality.

Study design

  • Retrospective cohort study evaluating cryptococcosis-related mortality in PLWH.
  • Funding: NIH.

Limitations

  • Nongeneralizable.
  • Length-time bias.
  • Omission errors.