1. Long-term outcome of AIDS-associated cryptococcosis in the era of combination antiretroviral therapy
- Author
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Lortholary, Olivier, Poizat, Gwendoline, Zeller, Valerie, Neuville, Segolene, Oibieux, André, Alvarez, Muriel, Dellarnonica, Pierre, Botterel, Françoise, Dromer, Françoise, Chêne, Geneviève, Groupe d'Etude de la Cryptococcose en France, ., Mycologie moléculaire, Institut Pasteur [Paris]-Centre National de la Recherche Scientifique (CNRS), Université Paris Descartes - Paris 5 (UPD5), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Bordeaux Ségalen [Bordeaux 2], CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hopital Saint-Louis [AP-HP] (AP-HP), Centre Hospitalier Universitaire de Lyon, CHU Toulouse [Toulouse], Hôpital L'Archet, Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital l'Archet, Unité mixte de recherche biologie moléculaire et immunologie parasitaires et fongiques, Institut National de la Recherche Agronomique (INRA)-École nationale vétérinaire d'Alfort (ENVA)-Agence Française de Sécurité Sanitaire des Aliments (AFSSA)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Institut Pasteur [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and Agence Française de Sécurité Sanitaire des Aliments (AFSSA)-École nationale vétérinaire - Alfort (ENVA)-Institut National de la Recherche Agronomique (INRA)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)
- Subjects
Adult ,Male ,Cart ,medicine.medical_specialty ,Antifungal Agents ,Antigens, Fungal ,POLYSSACCHARIDE ,[SDV]Life Sciences [q-bio] ,Immunology ,CRYPTOCOCCOSIS ,03 medical and health sciences ,0302 clinical medicine ,Maintenance therapy ,Recurrence ,Antiretroviral Therapy, Highly Active ,Internal medicine ,Humans ,Immunology and Allergy ,Medicine ,030212 general & internal medicine ,Fluconazole ,Mycosis ,Retrospective Studies ,OUTCOME ,First episode ,0303 health sciences ,AIDS-Related Opportunistic Infections ,C-ART ,030306 microbiology ,business.industry ,Mortality rate ,medicine.disease ,3. Good health ,Surgery ,Survival Rate ,Treatment Outcome ,Infectious Diseases ,Relative risk ,Cohort ,Cryptococcosis ,SURVIVAL ,Female ,IMMUNE RESTORATION ,business ,Follow-Up Studies - Abstract
International audience; Background: Immune restoration following combination antiretroviral therapy (cART) questions the maintenance of prophylaxis among HIV-infected patients with cryptococcosis. Objective: To describe the long-term outcome after the diagnosis of cryptococcosis at the cART era. Design: Multicentre cohort of patients with a diagnosis of cryptococcosis between 1996 and 2000, follow-up until December 2002. Comparison with a historical cohort (1990-1994) for survival. Setting: Eighty-four French AIDS clinical centres. Patients: Two-hundred and forty HIV-infected adult patients at the cART era and 149 at the pre-cART era experiencing a first episode of culture-confirmed cryptococcosis. Results: In the cART era, 82/189 patients surviving more than 3 months after initiation of antifungal therapy had their maintenance therapy interrupted with a subsequent median follow-up of 19 months. Their relapse rate per 100 person-years was 0.9 [95% confidence interval (CI),0.0-2.0]. When considering the whole cART cohort, probability of reaching negative serum cryptococcal antigen was 71% after 48 months of follow-up. A CD4 cell count < 100/mu l [relative risk (RR), 5.5; 95% Cl, 1.3-22.2], antifungal therapy < 3 months over the past 6 months [RR, 5.0; 95% CI, 1.1-22.3] and serum cryptococcal antigen titre > 1/512 [RR, 3.5; 95% Cl, 1.1-10.8] were associated with a higher rate of cryptococcosis relapse. The mortality rate per 100 person-years was 15.3 [95% CI,12.2-18.4] in the cART era versus 63.8 [95% CI,53.0-74.91 in the pre-cART era although early mortality did not differ between the two periods. Conclusion: Overall survival after cryptococcosis has dramatically improved at the cART era. immune restoration and low serum cryptococcal antigen titres are associated with lower cryptococcosis relapse rates.
- Published
- 2006