Prognosis and management of cryptococcal meningitis in patients with human immunodeficiency virus infection

Neurobehavioral HIV Medicine

Volumn 4, Issue 1, 2012, Pages 45-61

  Rhein, Joshua ^a   Boulware, David R ^a  

^a UNIVERSITY OF MINNESOTA MEDICAL SCHOOL   (United States)

Author keywords

Acquired immune deficiency syndrome; Antifungal therapy; Antiretroviral therapy; Cryptococcal meningitis; Human immunodeficiency virus; Immune reconstitution inflammatory syndrome

Indexed keywords

ACETAZOLAMIDE; AMPHOTERICIN B; AMPHOTERICIN B DEOXYCHOLATE; AMPHOTERICIN B LIPID COMPLEX; ANTIFUNGAL AGENT; ANTIRETROVIRUS AGENT; CORTICOSTEROID; FLUCONAZOLE; FLUCYTOSINE; FUNGUS ANTIGEN; GAMMA INTERFERON; MAGNESIUM; POTASSIUM; VORICONAZOLE;

ACQUIRED IMMUNE DEFICIENCY SYNDROME; ACUTE KIDNEY FAILURE; ADD ON THERAPY; AFRICA; ANTIGEN DETECTION; BLOOD CULTURE; CD4 LYMPHOCYTE COUNT; CEREBROSPINAL FLUID CULTURE; CLINICAL PRACTICE; COLONY FORMING UNIT; CRYPTOCOCCAL MENINGITIS; CRYPTOCOCCOSIS; CRYPTOCOCCUS NEOFORMANS; DIAGNOSTIC ACCURACY; DIAGNOSTIC TEST; DISEASE COURSE; DISEASE SEVERITY; DRUG COST; DRUG DOSE COMPARISON; DRUG DOSE INCREASE; DRUG EFFICACY; DRUG FORMULATION; DRUG MEGADOSE; DRUG SAFETY; DRUG WITHDRAWAL; ENZYME LINKED IMMUNOSORBENT ASSAY; FOLLOW UP; FUNGICIDAL ACTIVITY; FUNGUS CULTURE; HEALTH CARE ACCESS; HIGHLY ACTIVE ANTIRETROVIRAL THERAPY; HUMAN; HUMAN IMMUNODEFICIENCY VIRUS INFECTED PATIENT; HUMAN IMMUNODEFICIENCY VIRUS INFECTION; HYPOKALEMIA; IMMUNE RECONSTITUTION INFLAMMATORY SYNDROME; IMMUNOASSAY; INCIDENCE; INTRACRANIAL HYPERTENSION; INTRACRANIAL PRESSURE; LATERAL FLOW ASSAY; LUMBAR PUNCTURE; METABOLIC DISORDER; MONOTHERAPY; MORTALITY; NEPHROTOXICITY; OPPORTUNISTIC INFECTION; PHASE 2 CLINICAL TRIAL (TOPIC); PHASE 3 CLINICAL TRIAL (TOPIC); PNEUMONIA; POINT OF CARE TESTING; PRACTICE GUIDELINE; RANDOMIZED CONTROLLED TRIAL (TOPIC); RECOMMENDED DRUG DOSE; RELAPSE; REVIEW; RISK FACTOR; SEPSIS; SURVIVAL RATE; TREATMENT OUTCOME; UNSPECIFIED SIDE EFFECT;

EID: 84863591165     PISSN: None     EISSN: 11791497     Source Type: Journal    
DOI: 10.2147/NBHIV.S24748     Document Type: Review

References (110)

1. Hajjeh RA, Brandt ME, Pinner RW. Emergence of cryptococcal disease: epidemiologic perspectives 100 years after its discovery. Epidemiol Rev. 1995;17(2):303-320.
2. Chayakulkeeree M, Perfect JR. Cryptococcosis. Infect Dis Clin North Am. 2006;20(3):507-544.
3. Powderly WG, Saag MS, Cloud GA, et al. A controlled trial of fluconazole or amphotericin B to prevent relapse of cryptococcal meningitis in patients with the acquired immunodeficiency syndrome. The NIAID AIDS Clinical Trials Group and Mycoses Study Group. N Engl J Med. 1992;326(12):793-798.
4. Mirza SA, Phelan M, Rimland D, et al. The changing epidemiology of cryptococcosis: an update from population-based active surveillance in 2 large metropolitan areas, 1992-2000. Clin Infect Dis. 2003;36(6): 789-794.
5. Kaplan JE, Hanson D, Dworkin MS, et al. Epidemiology of human immunodeficiency virus-associated opportunistic infections in the United States in the era of highly active antiretroviral therapy. Clin Infect Dis. 2000;30 Suppl 1:S5-S14.
6. Park BJ, Wannemuehler KA, Marston BJ, Govender N, Pappas PG, Chiller TM. Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS. AIDS. 2009;23(4): 525-530.
7. Lortholary O, Poizat G, Zeller V, et al. Long-term outcome of AIDS-associated cryptococcosis in the era of combination antiretroviral therapy. AIDS. 2006;20(17):2183-2191.
8. Jarvis JN, Boulle A, Loyse A, et al. High ongoing burden of cryptococcal disease in Africa despite antiretroviral roll out. AIDS. 2009;23(9): 1182-1183.
9. Bicanic T, Wood R, Meintjes G, et al. High-dose amphotericin B with flucytosine for the treatment of cryptococcal meningitis in HIV-infected patients: a randomized trial. Clin Infect Dis. 2008;47(1): 123-130.
10. Park BJ, Shetty S, Ahlquist A, et al. Long-term follow-up and survival of antiretroviral-naive patients with cryptococcal meningitis in the pre-antiretroviral therapy era, Gauteng Province, South Africa. Int J STD AIDS. 2011;22(4):199-203.
11. Longley N, Muzoora C, Taseera K, et al. Dose response effect of high-dose fluconazole for HIV-associated cryptococcal meningitis in southwestern Uganda. Clin Infect Dis. 2008;47(12):1556-1561.
12. Kambugu A, Meya DB, Rhein J, et al. Outcomes of cryptococcal meningitis in Uganda before and after the availability of highly active antiretroviral therapy. Clin Infect Dis. 2008;46(11):1694-1701.
13. Wajanga BM, Kalluvya S, Downs JA, Johnson WD, Fitzgerald DW, Peck RN. Universal screening of Tanzanian HIV-infected adult inpatients with the serum cryptococcal antigen to improve diagnosis and reduce mortality: an operational study. J Int AIDS Soc. 2011;14:48.
14. Jarvis JN, Meintjes G, Williams A, Brown Y, Crede T, Harrison TS. Adult meningitis in a setting of high HIV and TB prevalence: findings from 4961suspected cases. BMC Infect Dis. 2010;10:67.
15. Hakim JG, Gangaidzo IT, Heyderman RS, et al. Impact of HIV infection on meningitis in Harare, Zimbabwe: a prospective study of 406 predominantly adult patients. AIDS. 2000;14(10):1401-1407.
16. French N, Gray K, Watera C, et al. Cryptococcal infection in a cohort of HIV-1-infected Ugandan adults. AIDS. 2002;16(7): 1031-1038.
17. Liechty CA, Solberg P, Were W, et al. Asymptomatic serum cryptococcal antigenemia and early mortality during antiretroviral therapy in rural Uganda. Trop Med Int Health. 2007;12(8):929-935.
18. Okongo M, Morgan D, Mayanja B, Ross A, Whitworth J. Causes of death in a rural, population-based human immunodeficiency virus type 1 (HIV-1) natural history cohort in Uganda. Int J Epidemiol. 1998;27(4):698-702.
19. Corbett EL, Churchyard GJ, Charalambos S, et al. Morbidity and mortality in South African gold miners: impact of untreated disease due to human immunodeficiency virus. Clin Infect Dis. 2002;34(9):1251-1258.
20. Boulware DR, Meya DB, Bergemann TL, et al. Clinical features and serum biomarkers in HIV immune reconstitution inflammatory syndrome after cryptococcal meningitis: a prospective cohort study. PLoS Med. 2010;7(12):e1000384.
21. Meya DB, Manabe YC, Castelnuovo B, et al. Cost-effectiveness of serum cryptococcal antigen screening to prevent deaths among HIV-infected persons with a CD4+ cell count ≤ 100 cells/μL who start HIV therapy in resource-limited settings. Clin Infect Dis. 2010;51(4):448-455.
22. Bicanic T, Brouwer AE, Meintjes G, et al. Relationship of cerebrospinal fluid pressure, fungal burden and outcome in patients with cryptococcal meningitis undergoing serial lumbar punctures. AIDS. 2009;23(6): 701-706.
23. Bicanic T, Harrison TS. Cryptococcal meningitis. Br Med Bull. 2004;72:99-118.
24. Bicanic T, Muzoora C, Brouwer AE, et al. Independent association between rate of clearance of infection and clinical outcome of HIV associated cryptococcal meningitis: analysis of a combined cohort of 262 patients. Clin Infect Dis. 2009;49(5):702-709.
25. Comparisons of clinical features and mortality of cryptococcal meningitis between patients with and without human immunodeficiency virus infection
26. Klock C, Cerski M, Goldani LZ. Histopathological aspects of neurocryptococcosis in HIV-infected patients: autopsy report of 45 patients. Int J Surg Pathol. 2009;17(6):444-448.
27. Loyse A, Wainwright H, Jarvis JN, et al. Histopathology of the arachnoid granulations and brain in HIV-associated cryptococcal meningitis: correlation with cerebrospinal fluid pressure. AIDS. 2010;24(3): 405-410.
28. Wijewardana I, Jarvis JN, Meintjes G, Harrison TS, Bicanic T. Large volume lumbar punctures in cryptococcal meningitis clear cryptococcal antigen as well as lowering pressure. J Infect. 2011;63(6):484-486.
29. Harris JR, Lindsley MD, Henchaichon S, et al. High prevalence of cryptococcal infection among HIV-infected patients hospitalized with pneumonia in Thailand. Clin Infect Dis. 2012;54(5):e43-e50.
30. Deok-jong Yoo S, Worodria W, Davis JL, et al. The prevalence and clinical course of HIV-associated pulmonary cryptococcosis in Uganda. J Acquir Immune Defic Syndr. 2010;54(3):269-274.
31. Jarvis JN, Wainwright H, Harrison TS, Rebe K, Meintjes G. Pulmonary cryptococcosis misdiagnosed as smear-negative pulmonary tuberculosis with fatal consequences. Int J Infect Dis. 2010;14 Suppl 3: e310-e312.
32. Jacob ST, Moore CC, Banura P, et al. Severe sepsis in two Ugandan hospitals: a prospective observational study of management and outcomes in a predominantly HIV-1 infected population. PLoS One. 2009;4(11):e7782.
33. Velagapudi R, Hsueh YP, Geunes-Boyer S, Wright JR, Heitman J. Spores as infectious propagules of Cryptococcus neoformans. Infect Immun. 2009;77(10):4345-4355.
34. Dromer F, Mathoulin-Pelissier S, Launay O, Lortholary O. French Cryptococcosis Study. Determinants of disease presentation and outcome during cryptococcosis: the CryptoA/D study. PLoS Med. 2007;4(2):e21.
35. Sajadi MM, Roddy KM, Chan-Tack KM, Forrest GN. Risk factors for mortality from primary cryptococcosis in patients with HIV. Postgrad Med. 2009;121(2):107-113.
36. Cameron ML, Bartlett JA, Gallis HA, Waskin HA. Manifestations of pulmonary cryptococcosis in patients with acquired immunodeficiency syndrome. Rev Infect Dis. 1991;13(1):64-67.
37. Graybill JR, Sobel J, Saag M, et al. Diagnosis and management of increased intracranial pressure in patients with AIDS and cryptococcal meningitis. The NIAID Mycoses Study Group and AIDS Cooperative Treatment Groups. Clin Infect Dis. 2000;30(1):47-54.
38. Cryptococcal infections of the central nervous system: an analysis of predisposing factors, laboratory findings and outcome in patients from South India with special reference to HIV infection
39. Darras-Joly C, Chevret S, Wolff M, et al. Cryptococcus neoformans infection in France: epidemiologic features of and early prognostic parameters for 76 patients who were infected with human immunodeficiency virus. Clin Infect Dis. 1996;23(2):369-376.
40. Boulware DR, Bonham SC, Meya DB, et al. Paucity of initial cerebrospinal fluid inflammation in cryptococcal meningitis is associated with subsequent immune reconstitution inflammatory syndrome. J Infect Dis. 2010;202(6):962-970.
41. Anekthananon T, Manosuthi W, Chetchotisakd P, et al. Predictors of poor clinical outcome of cryptococcal meningitis in HIV-infected patients. Int J STD AIDS. 2011;22(11):665-670.
42. Taniguchi T, Ogawa Y, Kasai D, et al. Three cases of fungemia in HIV-infected patients diagnosed through the use of mycobacterial blood culture bottles. Intern Med. 2010;49(19):2179-2183.
43. Lindsley MD, Mekha N, Baggett HC, et al. Evaluation of a newly developed lateral flow immunoassay for the diagnosis of cryptococcosis. Clin Infect Dis. 2011;53(4):321-325.
44. Temstet A, Roux P, Poirot JL, Ronin O, Dromer F. Evaluation of a monoclonal antibody-based latex agglutination test for diagnosis of cryptococcosis: comparison with two tests using polyclonal antibodies. J Clin Microbiol. 1992;30(10):2544-2550.
45. Asawavichienjinda T, Sitthi-Amorn C, Tanyanont V. Serum cyrptococcal antigen: diagnostic value in the diagnosis of AIDS-related cryptococcal meningitis. J Med Assoc Thai. 1999;82(1):65-71.
46. Jarvis JN, Lawn SD, Vogt M, Bangani N, Wood R, Harrison TS. Screening for cryptococcal antigenemia in patients accessing an antiretroviral treatment program in South Africa. Clin Infect Dis. 2009;48(7):856-862.
47. Powderly WG, Cloud GA, Dismukes WE, Saag MS. Measurement of cryptococcal antigen in serum and cerebrospinal fluid: value in the management of AIDS-associated cryptococcal meningitis. Clin Infect Dis. 1994;18(5):789-792.
48. Aberg JA, Watson J, Segal M, Chang LW. Clinical utility of monitoring serum cryptococcal antigen (sCRAG) titers in patients with AIDS-related cryptococcal disease. HIV Clin Trials. 2000;1(1):1-6.
49. Sungkanuparph S, Filler SG, Chetchotisakd P, et al. Cryptococcal immune reconstitution inflammatory syndrome after antiretroviral therapy in AIDS patients with cryptococcal meningitis: a prospective multicenter study. Clin Infect Dis. 2009;49(6):931-934.
50. World Health Organization. Rapid advice: Diagnosis, prevention and management of cryptococcal disease in HIV-infected adults, adolescents and children, 2011. Available from: http://www.who.int/hiv/pub/cryptococcal_disease2011. Accessed April 3, 2012.
51. Jarvis JN, Percival A, Bauman S, et al. Evaluation of a novel point-of-care cryptococcal antigen test on serum, plasma, and urine from patients with HIV-associated cryptococcal meningitis. Clin Infect Dis. 2011;53(10):1019-1023.
52. Perfect JR, Dismukes WE, Dromer F, et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2010;50(3): 291-322.
53. Saag MS, Powderly WG, Cloud GA, et al. Comparison of amphotericin B with fluconazole in the treatment of acute AIDS-associated cryptococcal meningitis. The NIAID Mycoses Study Group and the AIDS Clinical Trials Group. N Engl J Med. 1992;326(2): 83-89.
54. van der Horst CM, Saag MS, Cloud GA, et al. Treatment of cryptococcal meningitis associated with the acquired immunodeficiency syndrome. National Institute of Allergy and Infectious Diseases Mycoses Study Group and AIDS Clinical Trials Group. N Engl J Med. 1997;337(1): 15-21.
55. Saag MS, Cloud GA, Graybill JR, et al. A comparison of itraconazole versus fluconazole as maintenance therapy for AIDS-associated cryptococcal meningitis. National Institute of Allergy and Infectious Diseases Mycoses Study Group. Clin Infect Dis. 1999;28(2): 291-296.
56. Brouwer AE, Rajanuwong A, Chierakul W, et al. Combination antifungal therapies for HIV-associated cryptococcal meningitis: a randomised trial. Lancet. 2004;363(9423):1764-1767.
57. Dromer F, Bernede-Bauduin C, Guillemot D, Lortholary O. Major role for amphotericin B-flucytosine combination in severe cryptococcosis. PLoS One. 2008;3(8):e2870.
58. Loyse A, Wilson D, Meintjes G, et al. Comparison of the early fungicidal activity of high-dose fluconazole, voriconazole, and flucytosine as second-line drugs given in combination with amphotericin B for the treatment of HIV-associated cryptococcal meningitis. Clin Infect Dis. 2012;54(1):121-128.
59. Bennett J. Companion drugs for amphotericin B in cryptococcal meningitis: flucytosine, fluconazole, or ... nothing? Clin Infect Dis. 2012;54(1):129-130.
60. Day JN. Combination antifungal therapy for HIV associated cryptococcal meningitis. Paper presented at the International Congress of Antimicrobial Agents and Chemotherapy. September 19, 2011; Chicago, IL.
61. Bahr N, Rolfes MAR, Musubire A, et al. The impact of routine electrolyte supplementation during amphotericin induction therapy in resource-limited settings. Paper presented at the 8th International Conference on Cryptococcus and Cryptococcosis. May 4, 2011; Charleston, SC.
62. Hamill RJ, Sobel JD, El-Sadr W, et al. Comparison of 2 doses of liposomal amphotericin B and conventional amphotericin B deoxycholate for treatment of AIDS-associated acute cryptococcal meningitis: a randomized, double-blind clinical trial of efficacy and safety. Clin Infect Dis. 2010;51(2):225-232.
63. Chen SC. Cryptococcosis in Australasia and the treatment of cryptococcal and other fungal infections with liposomal amphotericin B. J Antimicrob Chemother. 2002;49 Suppl 1:57-61.
64. Bicanic T, Wood R, Bekker LG, Darder M, Meintjes G, Harrison TS. Antiretroviral roll-out, antifungal roll-back: access to treatment for cryptococcal meningitis. Lancet Infect Dis. 2005;5(9):530-531.
65. Wertheimer AI, Santella TM, Lauver HJ. Successful public/private donation programs: a review of the Diflucan Partnership Program in South Africa. J Int Assoc Physicians AIDS Care (Chic). 2004;3(3): 74-79.
66. Schaars CF, Meintjes GA, Morroni C, Post FA, Maartens G. Outcome of AIDS-associated cryptococcal meningitis initially treated with 200 mg/day or 400 mg/day of fluconazole. BMC Infect Dis. 2006;6:118.
67. Mwaba P, Mwansa J, Chintu C, et al. Clinical presentation, natural history, and cumulative death rates of 230 adults with primary cryptococcal meningitis in Zambian AIDS patients treated under local conditions. Postgrad Med J. 2001;77(914):769-773.
68. Bicanic T, Meintjes G, Wood R, et al. Fungal burden, early fungicidal activity, and outcome in cryptococcal meningitis in antiretroviral-naive or antiretroviral-experienced patients treated with amphotericin B or fluconazole. Clin Infect Dis. 2007;45(1):76-80.
69. Bicanic T, Harrison T, Niepieklo A, Dyakopu N, Meintjes G. Symptomatic relapse of HIV-associated cryptococcal meningitis after initial fluconazole monotherapy: the role of fluconazole resistance and immune reconstitution. Clin Infect Dis. 2006;43(8):1069-1073.
70. Bii CC, Makimura K, Abe S, et al. Antifungal drug susceptibility of Cryptococcus neoformans from clinical sources in Nairobi, Kenya. Mycoses. 2007;50(1):25-30.
71. Muzoora CK, Kabanda T, Ortu G, et al. Short course amphotericin B with high dose fluconazole for HIV-associated cryptococcal meningitis. J Infect. 2012;64(1):76-81.
72. Anaissie EJ, Kontoyiannis DP, Huls C, et al. Safety, plasma concentrations, and efficacy of high-dose fluconazole in invasive mold infections. J Infect Dis. 1995;172(2):599-602.
73. Jackson A, Nussbaum J, Phulusa J, et al. A phase II randomised controlled trial adding oral flucytosine to high dose fluconazole, with short-course amphotericin B, for cryptococcal meningitis in Malawi. AIDS. 2012; In Press.
74. Nussbaum JC, Jackson A, Namarika D, et al. Combination flucytosine and high-dose fluconazole compared with fluconazole monotherapy for the treatment of cryptococcal meningitis: a randomized trial in Malawi. Clin Infect Dis. 2010;50(3):338-344.
75. Pappas PG, Chetchotisakd P, Larsen RA, et al. A Phase II randomized trial of amphotericin B alone or combined with fluconazole in the treatment of HIV-associated cryptococcal meningitis. Clin Infect Dis. 2009;48(12):1775-1783.
76. Govender NP, Patel J, van Wyk M, Chiller TM, Lockhart SR. Trends in antifungal drug susceptibility of Cryptococcus neoformans isolates obtained through population-based surveillance in South Africa in 2002-2003 and 2007-2008. Antimicrob Agents Chemother. 2011;55(6):2606-2611.
77. Mdodo R, Moser SA, Jaoko W, et al. Antifungal susceptibilities of Cryptococcus neoformans cerebrospinal fluid isolates from AIDS patients in Kenya. Mycoses. 2011;54(5):e438-e442.
78. Pappas PG, Bustamante B, Ticona E, et al. Recombinant interferon-gamma 1b as adjunctive therapy for AIDS-related acute cryptococcal meningitis. J Infect Dis. 2004;189(12):2185-2191.
79. Jarvis JN, Meintjes G, Rebe K, et al. Adjunctive interferon-gamma immunotherapy for the treatment of HIV-associated cryptococcal meningitis: a randomized controlled trial. AIDS. March 20, 2012. [Epub ahead of print.]
80. Bozzette SA, Larsen RA, Chiu J, et al. A placebo-controlled trial of maintenance therapy with fluconazole after treatment of cryptococcal meningitis in the acquired immunodeficiency syndrome. California Collaborative Treatment Group. N Engl J Med. 1991;324(9): 580-584.
81. Jarvis JN, Meintjes G, Williams Z, Rebe K, Harrison TS. Symptomatic relapse of HIV-associated cryptococcal meningitis in South Africa: the role of inadequate secondary prophylaxis. S Afr Med J. 2010;100(6):378-382.
82. Vibhagool A, Sungkanuparph S, Mootsikapun P, et al. Discontinuation of secondary prophylaxis for cryptococcal meningitis in human immunodeficiency virus-infected patients treated with highly active antiretroviral therapy: a prospective, multicenter, randomized study. Clin Infect Dis. 2003;36(10):1329-1331.
83. Mussini C, Pezzotti P, Miro JM, et al. Discontinuation of maintenance therapy for cryptococcal meningitis in patients with AIDS treated with highly active antiretroviral therapy: an international observational study. Clin Infect Dis. 2004;38(4):565-571.
84. Aller AI, Martin-Mazuelos E, Lozano F, et al. Correlation of fluconazole MICs with clinical outcome in cryptococcal infection. Antimicrob Agents Chemother. 2000;44(6):1544-1548.
85. Shoham S, Cover C, Donegan N, Fulnecky E, Kumar P. Cryptococcus neoformans meningitis at 2 hospitals in Washington, DC: adherence of health care providers to published practice guidelines for the management of cryptococcal disease. Clin Infect Dis. 2005;40(3):477-479.
86. Newton PN, Thai le H, Tip NQ, et al. A randomized, double-blind, placebo-controlled trial of acetazolamide for the treatment of elevated intracranial pressure in cryptococcal meningitis. Clin Infect Dis. 2002;35(6):769-772.
87. Haddow LJ, Colebunders R, Meintjes G, et al. Cryptococcal immune reconstitution inflammatory syndrome in HIV-1-infected individuals: proposed clinical case definitions. Lancet Infect Dis. 2010;10(11):791-802.
88. Rajasingham R, Meya DB, Boulware DR. Integrating cryptococcal antigen screening and pre-emptive treatment into routine HIV care. J Acquir Immune Defic Syndr. 2012;59(5):85-91.
89. Micol R, Lortholary O, Sar B, et al. Prevalence, determinants of positivity, and clinical utility of cryptococcal antigenemia in Cambodian HIV-infected patients. J Acquir Immune Defic Syndr. 2007;45(5):555-559.
90. Jarvis JN, Meintjes G, Wood R, Harrison TS. Testing but not treating: missed opportunities and lost lives in the South African antiretroviral therapy programme. AIDS. 2010;24(8):1233-1235.
91. Oyella J, Meya D, Bajunirwe F, Kamya MR. Prevalence and factors associated with cryptococcal antigenemia among severely immunosuppressed HIV-infected adults in Uganda: a cross-sectional study. J Int AIDS Soc. 2012;15(1):15.
92. Jarvis JN, Meintjes G, Harrison TS. Outcomes of cryptococcal meningitis in antiretroviral naive and experienced patients in South Africa. J Infect. 2010;60(6):496-498.
93. Lawn SD, Bekker LG, Myer L, Orrell C, Wood R. Cryptococcocal immune reconstitution disease: a major cause of early mortality in a South African antiretroviral programme. AIDS. 2005;19(17):2050-2052.
94. Butler E, Meya DB, Boulware DR. Early treatment of Cryptococcal antigenemia improves long-term survival as compared with treatment of symptomatic Cryptococcal meningitis in persons with HIV/AIDS. Abstract 76.005 presented at the 2011 Global Health Conference. November 14, 2011; Montreal, Canada.
95. Jenny-Avital ER, Abadi M. Immune reconstitution cryptococcosis after initiation of successful highly active antiretroviral therapy. Clin Infect Dis. 2002;35(12):e128-e133.
96. Skiest DJ, Hester LJ, Hardy RD. Cryptococcal immune reconstitution inflammatory syndrome: report of four cases in three patients and review of the literature. J Infect. 2005;51(5):e289-e297.
97. Shelburne SA 3rd, Darcourt J, White AC Jr, et al. The role of immune reconstitution inflammatory syndrome in AIDS-related Cryptococcus neoformans disease in the era of highly active antiretroviral therapy. Clin Infect Dis. 2005;40(7):1049-1052.
98. Sungkanuparph S, Jongwutiwes U, Kiertiburanakul S. Timing of cryptococcal immune reconstitution inflammatory syndrome after antiretroviral therapy in patients with AIDS and cryptococcal meningitis. J Acquir Immune Defic Syndr. 2007;45(5):595-596.
99. Bicanic T, Meintjes G, Rebe K, et al. Immune reconstitution inflammatory syndrome in HIV-associated cryptococcal meningitis: a prospective study. J Acquir Immune Defic Syndr. 2009;51(2):130-134.
100. Lortholary O, Fontanet A, Memain N, et al. Incidence and risk factors of immune reconstitution inflammatory syndrome complicating HIV-associated cryptococcosis in France. AIDS. 2005;19(10): 1043-1049.
101. Huits RM, Bremmer R, Enting RH, Sprenger HG, van Assen S. Return of meningeal symptoms in a patient treated for cryptococcal meningitis. J Neurol. 2007;254(10):1443-1444.
102. Meintjes G, Wilkinson RJ, Morroni C, et al. Randomized placebo-controlled trial of prednisone for paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome. AIDS. 2010;24(15):2381-2390.
103. Lesho E. Evidence base for using corticosteroids to treat HIV-associated immune reconstitution syndrome. Expert Rev Anti Infect Ther. 2006;4(3):469-478.
104. Brown M, Bukusuba J, Hughes P, et al. Screening for intestinal helminth infestation in a semi-urban cohort of HIV-infected people in Uganda: a combination of techniques may enhance diagnostic yield in the absence of multiple stool samples. Trop Doct. 2003;33(2):72-76.
105. Boulware DR, Stauffer WM, Hendel-Paterson BR, et al. Maltreatment of Strongyloides infection: case series and worldwide physicians-in-training survey. Am J Med. 2007;120(6):e541-e548.
106. Zolopa A, Andersen J, Powderly W, et al. Early antiretroviral therapy reduces AIDS progression/death in individuals with acute opportunistic infections: a multicenter randomized strategy trial. PLoS One. 2009;4(5):e5575.
107. Abdool Karim SS, Naidoo K, Grobler A, et al. Timing of initiation of antiretroviral drugs during tuberculosis therapy. N Engl J Med. 2010;362(8):697-706.
108. Manosuthi W, Sungkanuparph S, Chottanapund S, et al. Temporary external lumbar drainage for reducing elevated intracranial pressure in HIV-infected patients with cryptococcal meningitis. Int J STD AIDS. 2008;19(4):268-271.
109. Grant PM, Komarow L, Andersen J, et al. Risk factor analyses for immune reconstitution inflammatory syndrome in a randomized study of early versus deferred ART during an opportunistic infection. PLoS One. 2010;5(7):e11416.
110. Makadzange AT, Ndhlovu CE, Takarinda K, et al. Early versus delayed initiation of antiretroviral therapy for concurrent HIV infection and cryptococcal meningitis in Sub-Saharan Africa. Clin Infect Dis. 2010;50(11):1532-1538.