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

Cristina Mussini, Patrizio Pezzotti, José M. Miró, Esteban Martinez, Juan Carlos Lopez Bernaldo De Quiros, Paola Cinque, Vanni Borghi, Andrea Bedini, Pere 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 LazzarinAndrea Cossarizza, Roberto Esposito, Andrea Antinori, Judith A. Aberg

Research output: Contribution to journalArticlepeer-review

Abstract

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 10 copies/mL, and serum cryptococcal antigen was undetectable in 56 patients. During a median followup period of 28.4 months (range, 6.7-64.5; 262 person-years), 4 events were observed (incidence, 1.53 events per 100 person-years; 95% confidence interval, 0.42-3.92). Three of these patients had a CD4 cell count of >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.

Original languageEnglish
Pages (from-to)565-571
Number of pages7
JournalClinical Infectious Diseases
Volume38
Issue number4
DOIs
Publication statusPublished - Feb 15 2004

ASJC Scopus subject areas

  • Immunology

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