1. A pragmatic approach to managing antiretroviral therapy-experienced patients diagnosed with HIV-associated cryptococcal meningitis: impact of antiretroviral therapy adherence and duration
- Author
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David R. Boulware, Henry C. Mwandumba, Thomas S. Harrison, Timothée Boyer-Chammard, Mosepele Mosepele, Chiratidzo E. Ndhlovu, Joshua Rhein, Síle F. Molloy, Lillian Tugume, Melanie Alufandika, Joseph N Jarvis, David S Lawrence, David B. Meya, Olivier Lortholary, Graeme Meintjes, Cecilia Kanyama, Charlotte Schutz, Conrad Muzoora, and Nabila Youssouf
- Subjects
0301 basic medicine ,Antifungal ,Pediatrics ,medicine.medical_specialty ,Antifungal Agents ,medicine.drug_class ,Art initiation ,Immunology ,Human immunodeficiency virus (HIV) ,MEDLINE ,HIV Infections ,Meningitis, Cryptococcal ,medicine.disease_cause ,Medication Adherence ,law.invention ,03 medical and health sciences ,Viewpoint ,0302 clinical medicine ,Randomized controlled trial ,law ,Antiretroviral Therapy, Highly Active ,Humans ,Immunology and Allergy ,Medicine ,030212 general & internal medicine ,AIDS-Related Opportunistic Infections ,business.industry ,Antiretroviral therapy ,Discontinuation ,Treatment Outcome ,030104 developmental biology ,Infectious Diseases ,Anti-Retroviral Agents ,business ,Cryptococcal meningitis - Abstract
Cryptococcal meningitis accounts for 15% of all HIV-related deaths [1]. The overall number of cryptococcal meningitis cases has remained relatively stable in many low-to-middle income countries (LMICs) despite increasing roll-out of antiretroviral therapy (ART). Increasing numbers of patients are at risk of developing cryptococcal meningitis following ART failure or discontinuation, offsetting declines in those presenting for the first time with advanced HIV [2–4]. Over half of patients diagnosed with cryptococcal meningitis in recent studies in sub-Saharan Africa are ART-experienced (i.e. currently receiving or previously received ART) [5,6]. Although there is robust evidence from prospective randomized trials that ART initiation should be delayed until 4–6 weeks after starting antifungal therapy in ART-naive cryptococcal meningitis patients [7,8], the approach to ART management among ART-experienced cryptococcal meningitis patients lacks adequate evidence, with a paucity of published data.
- Published
- 2020