Journal Article

Discontinuation of Maintenance Therapy for Cryptococcal Meningitis in Patients with AIDS Treated with Highly Active Antiretroviral Therapy: An International Observational Study

Cristina Mussini, Patrizio Pezzotti, José M. Miró, Esteban Martinez, Juan Carlos Lopez Bernaldo de Quiros, Paola Cinque, Vanni Borghi, Andrea Bedini, Pere Domingo, Pedro Cahn, Philippe Bossi, Andrea De Luca, Antonella d'Arminio Monforte, Mark Nelson, Nneka Nwokolo, Silvia Helou, Ricardo Negroni, Gaia Jacchetti, Spinello Antinori, Adriano Lazzarin, Andrea Cossarizza, Roberto Esposito, Andrea Antinori and Judith A. Aberg

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 38, issue 4, pages 565-571
Published in print February 2004 | ISSN: 1058-4838
Published online February 2004 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/381261
Discontinuation of Maintenance Therapy for Cryptococcal Meningitis in Patients with AIDS Treated with Highly Active Antiretroviral Therapy: An International Observational Study

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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/µL 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/µL 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/µL 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/µL 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.

Journal Article.  3922 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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