Original articles

Poor long-term outcomes for cryptococcal meningitis in rural South Africa

Richard J Lessells, Portia C Mutevedzi, Tom Heller, Marie-Louise Newell

Abstract


Objectives. To explore linkage to and retention in HIV care after an episode of cryptococcal meningitis (CM) in rural South Africa.
Design. A retrospective case series of adult individuals (≥16 years old) with laboratory-confirmed CM from January - December 2007 at Hlabisa Hospital – a district hospital in northern KwaZulu-Natal.
Outcome measures. Inpatient mortality and associated risk factors were analysed. The proportion alive and on antiretroviral therapy (ART) at 2 years was determined by linkage to the HIV treatment programme.
Results. One hundred and four individuals were identified with laboratory diagnosis of CM; 74/104 (71.2%) with complete records were included in analysis. Inpatient mortality was high (40.5%) and was significantly associated with reduced conscious level (aHR 3.09, 95% CI 1.30 - 7.33) and absence of headache (aHR 0.33 for headache, 95% CI 0.13 - 0.87). Only 8 individuals (10.8% of all study subjects) were alive and receiving ART 2 years after the CM episode.
Conclusions. Long-term outcomes of CM are poor in routine practice. Interventions to strengthen linkage to HIV treatment and care and continuation of secondary fluconazole prophylaxis are critical.

Authors' affiliations

Richard J Lessells, Africa Centre for Health & Population Studies

Portia C Mutevedzi, Africa Centre for Health and Population Studies

Tom Heller, Hlabisa Hospital

Marie-Louise Newell, Africa Centre for Health and Population Studies

Full Text

PDF (91KB)

Keywords

Cryptococcal meningitis; HIV; Antiretroviral therapy; Resource-limited setting

Cite this article

South African Medical Journal 2011;101(4):251-252.

Article History

Date submitted: 2010-07-09
Date published: 2011-04-04

Article Views

Abstract views: 1629
Full text views: 898

Comments on this article

*Read our policy for posting comments here