Mortality in first-episode HIV-associated cryptococcal meningitis in Peru
Cryptococcal meningitis (CM) remains one of the leading causes of morbidity and mortality among people living with HIV, particularly in low and middle-income countries where access to standard antifungal therapy is limited. Despite global advances in HIV care, early diagnosis and effective treatment...
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2025
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| author | Juan José Montenegro-Idrogo Luz A. Quispe-Gárate Blanca Salazar Sami Alcedo Paola L Rondan Jorge Arévalo Alfredo Chiappe-Gonzalez Jaime Soria |
| author_browse | Alfredo Chiappe-Gonzalez Blanca Salazar Jaime Soria Jorge Arévalo Juan José Montenegro-Idrogo Luz A. Quispe-Gárate Paola L Rondan Sami Alcedo |
| author_facet | Juan José Montenegro-Idrogo Luz A. Quispe-Gárate Blanca Salazar Sami Alcedo Paola L Rondan Jorge Arévalo Alfredo Chiappe-Gonzalez Jaime Soria |
| author_sort | Juan José Montenegro-Idrogo |
| collection | Producción científica |
| description | Cryptococcal meningitis (CM) remains one of the leading causes of morbidity and mortality among people living with HIV, particularly in low and middle-income countries where access to standard antifungal therapy is limited. Despite global advances in HIV care, early diagnosis and effective treatment of cryptococcal disease continue to represent major challenges in resource-limited settings. We conducted a retrospective registry-based cohort study of HIV patients and a first episode of CM admitted to a Peruvian national referral hospital between 2005 and 2015. Cox proportional hazards models were used to identify independent variables related to 30- and 90-day mortality. A total of 83 patients were included, 87% were males with a median age (interquartile range) of 33.8 (28.7-45.1) years. At baseline, 27.7% of patients had received antiretroviral therapy. Mortality at 30 and 90 days was 26.5% and 31.3%, respectively. In multivariable Cox models, the limited sample availability (59 for baseline and 83 for treatment analyses), constrained the precision estimates; nevertheless, altered consciousness, hyponatremia, and headache as independent predictors of mortality [30-day Hazard Ratios (HR): 7.6 (2.2-26.0); 5.4 (1.6-18.2); 0.1 (0.02-0.4); and 90-day HR: 7.1 (2.0-26.0); 10.9 (2.8-41.8); 0.1 (0.02-0.4), respectively]. In treatment analyses, fluconazole monotherapy or the absence of antifungals were significantly associated with higher mortality [30-day HR: 2.7 (1.1-6.8); 21.1 (7.8-57.5) and 90-day HR: HR: 2.8 (1.1-7.3); 20.1 (7.4-54.5), respectively]. In resource-limited settings, mortality from HIV-associated CM remains unacceptably high. These findings underscore the urgent need to enhance early diagnostic strategies and ensure access to optimal antifungal therapy to improve survival outcomes. |
| format | Article |
| id | oai:cris.upeu.edu.pe:20.500.15037/887 |
| institution | UPeU |
| language | English |
| publishDate | 2025 |
| publishDateRange | 2025 |
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| spelling | oai:cris.upeu.edu.pe:20.500.15037/8872026-10-30T16:14:57ZMortality in first-episode HIV-associated cryptococcal meningitis in PeruJuan José Montenegro-IdrogoLuz A. Quispe-GárateBlanca SalazarSami AlcedoPaola L RondanJorge ArévaloAlfredo Chiappe-GonzalezJaime SoriaMedicineCryptococcal meningitisProportional hazards modelReferralFluconazoleCryptococcosisCohortMortality rateRetrospective cohort studyHazard ratioPediatricsInternal medicineCryptococcusMeningitisDiseaseAntiretroviral therapyRisk of mortalityCohort studyIntensive care medicineSurvival analysisHuman immunodeficiency virus (HIV)AntifungalYoung adultCryptococcus neoformansCase fatality rateCause of deathBurden of diseaseEpidemiologyExpanded accessMycosisSidaCoinfectionCryptococcal meningitisProportional hazards modelReferralFluconazoleCryptococcosisCohortMortality rateRetrospective cohort studyHazard ratioCryptococcusAdultAdultAdultAntifungal Agents therapeutic useAntifungal Agents therapeutic useAntifungal Agents therapeutic useFemaleFemaleFemaleHumansHumansHumansMaleMaleMaleMiddle AgedMiddle AgedMiddle AgedPeru epidemiologyPeru epidemiologyPeru epidemiologyRetrospective StudiesRetrospective StudiesRetrospective StudiesHIV Infections complicationsHIV Infections complicationsHIV Infections complicationsSurvival AnalysisSurvival AnalysisSurvival AnalysisMeningitis, Cryptococcal drug therapyMeningitis, Cryptococcal drug therapyMeningitis, Cryptococcal drug therapyMeningitis, Cryptococcal mortalityMeningitis, Cryptococcal mortalityMeningitis, Cryptococcal mortalityAIDS-Related Opportunistic Infections drug therapyAIDS-Related Opportunistic Infections drug therapyAIDS-Related Opportunistic Infections drug therapyAIDS-Related Opportunistic Infections mortalityAIDS-Related Opportunistic Infections mortalityAIDS-Related Opportunistic Infections mortalityHealth Sciences Medicine Epidemiology Fungal Infections and StudiesHealth Sciences Medicine Epidemiology Nail Diseases and TreatmentsPhysical Sciences Environmental Science Health, Toxicology and Mutagenesis Insects and Parasite InteractionsCryptococcal meningitis (CM) remains one of the leading causes of morbidity and mortality among people living with HIV, particularly in low and middle-income countries where access to standard antifungal therapy is limited. Despite global advances in HIV care, early diagnosis and effective treatment of cryptococcal disease continue to represent major challenges in resource-limited settings. We conducted a retrospective registry-based cohort study of HIV patients and a first episode of CM admitted to a Peruvian national referral hospital between 2005 and 2015. Cox proportional hazards models were used to identify independent variables related to 30- and 90-day mortality. A total of 83 patients were included, 87% were males with a median age (interquartile range) of 33.8 (28.7-45.1) years. At baseline, 27.7% of patients had received antiretroviral therapy. Mortality at 30 and 90 days was 26.5% and 31.3%, respectively. In multivariable Cox models, the limited sample availability (59 for baseline and 83 for treatment analyses), constrained the precision estimates; nevertheless, altered consciousness, hyponatremia, and headache as independent predictors of mortality [30-day Hazard Ratios (HR): 7.6 (2.2-26.0); 5.4 (1.6-18.2); 0.1 (0.02-0.4); and 90-day HR: 7.1 (2.0-26.0); 10.9 (2.8-41.8); 0.1 (0.02-0.4), respectively]. In treatment analyses, fluconazole monotherapy or the absence of antifungals were significantly associated with higher mortality [30-day HR: 2.7 (1.1-6.8); 21.1 (7.8-57.5) and 90-day HR: HR: 2.8 (1.1-7.3); 20.1 (7.4-54.5), respectively]. In resource-limited settings, mortality from HIV-associated CM remains unacceptably high. These findings underscore the urgent need to enhance early diagnostic strategies and ensure access to optimal antifungal therapy to improve survival outcomes.Articlehttps://pubmed.ncbi.nlm.nih.gov/4143227810.1093/mmy/myaf123https://hdl.handle.net/20.500.15037/887W7116954731enMedical Mycology1369-37861460-27092025-12-232026-06-13T09:39:37Z2026-06-13T09:39:37Z |
| spellingShingle | Medicine Cryptococcal meningitis Proportional hazards model Referral Fluconazole Cryptococcosis Cohort Mortality rate Retrospective cohort study Hazard ratio Pediatrics Internal medicine Cryptococcus Meningitis Disease Antiretroviral therapy Risk of mortality Cohort study Intensive care medicine Survival analysis Human immunodeficiency virus (HIV) Antifungal Young adult Cryptococcus neoformans Case fatality rate Cause of death Burden of disease Epidemiology Expanded access Mycosis Sida Coinfection Cryptococcal meningitis Proportional hazards model Referral Fluconazole Cryptococcosis Cohort Mortality rate Retrospective cohort study Hazard ratio Cryptococcus Adult Adult Adult Antifungal Agents therapeutic use Antifungal Agents therapeutic use Antifungal Agents therapeutic use Female Female Female Humans Humans Humans Male Male Male Middle Aged Middle Aged Middle Aged Peru epidemiology Peru epidemiology Peru epidemiology Retrospective Studies Retrospective Studies Retrospective Studies HIV Infections complications HIV Infections complications HIV Infections complications Survival Analysis Survival Analysis Survival Analysis Meningitis, Cryptococcal drug therapy Meningitis, Cryptococcal drug therapy Meningitis, Cryptococcal drug therapy Meningitis, Cryptococcal mortality Meningitis, Cryptococcal mortality Meningitis, Cryptococcal mortality AIDS-Related Opportunistic Infections drug therapy AIDS-Related Opportunistic Infections drug therapy AIDS-Related Opportunistic Infections drug therapy AIDS-Related Opportunistic Infections mortality AIDS-Related Opportunistic Infections mortality AIDS-Related Opportunistic Infections mortality Health Sciences Medicine Epidemiology Fungal Infections and Studies Health Sciences Medicine Epidemiology Nail Diseases and Treatments Physical Sciences Environmental Science Health, Toxicology and Mutagenesis Insects and Parasite Interactions Juan José Montenegro-Idrogo Luz A. Quispe-Gárate Blanca Salazar Sami Alcedo Paola L Rondan Jorge Arévalo Alfredo Chiappe-Gonzalez Jaime Soria Mortality in first-episode HIV-associated cryptococcal meningitis in Peru |
| title | Mortality in first-episode HIV-associated cryptococcal meningitis in Peru |
| title_full | Mortality in first-episode HIV-associated cryptococcal meningitis in Peru |
| title_fullStr | Mortality in first-episode HIV-associated cryptococcal meningitis in Peru |
| title_full_unstemmed | Mortality in first-episode HIV-associated cryptococcal meningitis in Peru |
| title_short | Mortality in first-episode HIV-associated cryptococcal meningitis in Peru |
| title_sort | mortality in first episode hiv associated cryptococcal meningitis in peru |
| topic | Medicine Cryptococcal meningitis Proportional hazards model Referral Fluconazole Cryptococcosis Cohort Mortality rate Retrospective cohort study Hazard ratio Pediatrics Internal medicine Cryptococcus Meningitis Disease Antiretroviral therapy Risk of mortality Cohort study Intensive care medicine Survival analysis Human immunodeficiency virus (HIV) Antifungal Young adult Cryptococcus neoformans Case fatality rate Cause of death Burden of disease Epidemiology Expanded access Mycosis Sida Coinfection Cryptococcal meningitis Proportional hazards model Referral Fluconazole Cryptococcosis Cohort Mortality rate Retrospective cohort study Hazard ratio Cryptococcus Adult Adult Adult Antifungal Agents therapeutic use Antifungal Agents therapeutic use Antifungal Agents therapeutic use Female Female Female Humans Humans Humans Male Male Male Middle Aged Middle Aged Middle Aged Peru epidemiology Peru epidemiology Peru epidemiology Retrospective Studies Retrospective Studies Retrospective Studies HIV Infections complications HIV Infections complications HIV Infections complications Survival Analysis Survival Analysis Survival Analysis Meningitis, Cryptococcal drug therapy Meningitis, Cryptococcal drug therapy Meningitis, Cryptococcal drug therapy Meningitis, Cryptococcal mortality Meningitis, Cryptococcal mortality Meningitis, Cryptococcal mortality AIDS-Related Opportunistic Infections drug therapy AIDS-Related Opportunistic Infections drug therapy AIDS-Related Opportunistic Infections drug therapy AIDS-Related Opportunistic Infections mortality AIDS-Related Opportunistic Infections mortality AIDS-Related Opportunistic Infections mortality Health Sciences Medicine Epidemiology Fungal Infections and Studies Health Sciences Medicine Epidemiology Nail Diseases and Treatments Physical Sciences Environmental Science Health, Toxicology and Mutagenesis Insects and Parasite Interactions |
| topic_facet | Medicine Cryptococcal meningitis Proportional hazards model Referral Fluconazole Cryptococcosis Cohort Mortality rate Retrospective cohort study Hazard ratio Pediatrics Internal medicine Cryptococcus Meningitis Disease Antiretroviral therapy Risk of mortality Cohort study Intensive care medicine Survival analysis Human immunodeficiency virus (HIV) Antifungal Young adult Cryptococcus neoformans Case fatality rate Cause of death Burden of disease Epidemiology Expanded access Mycosis Sida Coinfection Cryptococcal meningitis Proportional hazards model Referral Fluconazole Cryptococcosis Cohort Mortality rate Retrospective cohort study Hazard ratio Cryptococcus Adult Adult Adult Antifungal Agents therapeutic use Antifungal Agents therapeutic use Antifungal Agents therapeutic use Female Female Female Humans Humans Humans Male Male Male Middle Aged Middle Aged Middle Aged Peru epidemiology Peru epidemiology Peru epidemiology Retrospective Studies Retrospective Studies Retrospective Studies HIV Infections complications HIV Infections complications HIV Infections complications Survival Analysis Survival Analysis Survival Analysis Meningitis, Cryptococcal drug therapy Meningitis, Cryptococcal drug therapy Meningitis, Cryptococcal drug therapy Meningitis, Cryptococcal mortality Meningitis, Cryptococcal mortality Meningitis, Cryptococcal mortality AIDS-Related Opportunistic Infections drug therapy AIDS-Related Opportunistic Infections drug therapy AIDS-Related Opportunistic Infections drug therapy AIDS-Related Opportunistic Infections mortality AIDS-Related Opportunistic Infections mortality AIDS-Related Opportunistic Infections mortality Health Sciences Medicine Epidemiology Fungal Infections and Studies Health Sciences Medicine Epidemiology Nail Diseases and Treatments Physical Sciences Environmental Science Health, Toxicology and Mutagenesis Insects and Parasite Interactions |
| url | https://pubmed.ncbi.nlm.nih.gov/41432278 https://hdl.handle.net/20.500.15037/887 |
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