Outcomes of a 24-month study of patients with HIV with Cryptococcal meningitis on high-dose fluconazole induction in Abidjan, Côte d'Ivoire, between 2012 and 2016.

Objectives: Cryptococcal meningitis (CM) is a common cause of meningitis in patients with AIDS in sub-Saharan Africa, with a mortality rate of over 50% at 10 weeks. The preferred treatment in resource-limited countries without access to amphotericin B or 5-fluorocytosine is high-dose fluconazole (FCZ). However, survival and factors associated with mortality after completion of FCZ-based treatment are not well known. To assess the outcomes at 24 months of patients with HIV with CM who have completed the initial FCZ treatment. Methods: Retrospective cohort study of adult patients with HIV with CM on oral FCZ 1200 mg/day induction, having completed 10 weeks of specific treatment between January 2012 and December 2016. The survival probability (not lost to follow-up or death) at 24 months was determined and the risk factors associated with death were identified using the Cox proportional hazard model. Results: Thirty-one (31) patients were enrolled from a total of 82. The median age was 42 years (38-44). Overall, 58% of the patients were female (n = 18) and 50% (14/28) were antiretroviral therapy experienced. The following outcomes were observed after 24 months of follow-up: 13 patients (41.9%) were lost to follow-up, 12 (38.7%) were still alive, 6 (19.3%) died, and 5 (16.1%) relapsed. The mortality rate was reduced by 77% where the clusters of differentiation 4 count was less than 100 cells/mm Conclusions: Long-term survival among patients with HIV with CM was poor. Interventions to strengthen linkage to HIV treatment and care and continuation of secondary fluconazole prophylaxis are critical.