Predictors of outcome in routine care for Cryptococcal meningitis in Western Kenya: lessons for HIV outpatient care in resource-limited settings. Issue 1048 (30th October 2012)

• Record Type: Journal Article
• Authors: Kendi, Caroline; Penner, Jeremy; Koech, Julius; Nyonda, Mary; Cohen, Craig R; Bukusi, Elizabeth A; Ngugi, Evelyn; Meyer, Ana-Claire Lew
• Is Part Of: Postgraduate medical journal. Volume 89:Issue 1048(2013)
• Page Start: 73
• Page End: 77
• Publication Date: 2012-10-30
• Subjects: HIV -- Kenya -- ambulatory care -- AIDS-Related Opportunistic Infection -- Meningitis, Cryptococcal; Medicine -- Periodicals; 610
• DOI: 10.1136/postgradmedj-2012-130823
• Languages: English
• ISSNs: 0032-5473

Abstract

Abstract : Purpose: Cryptococcal meningitis is a leading cause of mortality among HIV-infected individuals in sub-Saharan Africa but little is known about its treatment and outcomes in decentralised HIV outpatient settings. We assessed adherence to treatment guidelines and determined predictors of survival. Design: A computerised laboratory database identified HIV-infected adults with cryptococcal meningitis at Family AIDS Care and Education Services in Nyanza Province, Kenya, between 2005–2009. Medical records were reviewed. Kaplan-Meier survival curves were generated. Bivariate and multivariate Cox proportional hazards models were used to determine associations between key clinical characteristics and survival. Results: Medical records were located for 79% (71/90). Mortality was 38% (27/71) over a median follow-up period of 201 days (IQR: 10–705 days). Adherence to local guidelines for treatment of cryptococcal meningitis was 48% (34/71). Higher body mass index was associated with improved survival (HR: 0.82, 95% CI (0.68 to 0.99)) even after controlling for factors such as age, CD4 cell count, receipt of highly active anti-retroviral therapy, and treatment with any anti-fungal therapy. Conclusions: Cryptococcal meningitis diagnosed in routine HIV outpatient settings is largely treated as an outpatient and adherence to treatment guidelines is poor. Body mass index is a critical independent predictor of outcome. Additional research to determine the most effective strategies to reduce premature mortality is urgently needed.