Any Benefit of Additional Therapy to Prevent Cryptococcal Meningitis in Patients with HIV Infection and Low-Titer Cryptococcal Antigenemia?

For persons with HIV infection and asymptomatic plasma cryptococcal antigen ≤1:80, adding a single dose of liposomal amphotericin B to fluconazole did not reduce risk for developing meningitis.

Cryptococcal meningitis (CM) remains the leading cause of AIDS-related mortality. That risk can be reduced by obtaining a plasma cryptococcal antigen (CrAg) and, if CrAg is positive, treating the patient with fluconazole for 24 weeks. However, even with this approach, mortality remains 50% higher than in CrAg-negative patients, with the risk for death greatest in patients with CrAg titers ≥1:160.

To assess the potential benefit of a single dose of liposomal amphotericin B (LAmB) in patients with positive plasma CrAg who are asymptomatic for CM, investigators in Uganda randomized 251 persons with HIV and asymptomatic cryptococcal antigenemia to receive 10 mg/kg LAmB intravenously once, followed by fluconazole, or to receive fluconazole alone …

Reviewing Author

Neil M. Ampel, MD

Disclosures

Editorial BoardsUpToDate

Leadership Positions in Professional SocietiesCoccidioidomycosis Study Group (Past President, Secretary, Treasurer)

Neil M. Ampel, MD

Disclosures

Editorial BoardsUpToDate

Leadership Positions in Professional SocietiesCoccidioidomycosis Study Group (Past President, Secretary, Treasurer)

Any Benefit of Additional Therapy to Prevent Cryptococcal Meningitis in Patients with HIV Infection and Low-Titer Cryptococcal Antigenemia?

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Reviewing Author