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

2004; Oxford University Press; Volume: 38; Issue: 4 Linguagem: Inglês

10.1086/381261

1537-6591

Cristina Mussini, Patrizio Pezzotti, José M. Miró, Estebán Martínez, Juan Carlos Lopez Bernaldo de Quirós, Paola Cinque, Vanni Borghi, Andrea Bedini, Peré 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, Judith A. Aberg,

HIV/AIDS oral health manifestations

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 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.