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Postgrad Med J 89:73-77 doi:10.1136/postgradmedj-2012-130823
  • Original article

Predictors of outcome in routine care for Cryptococcal meningitis in Western Kenya: lessons for HIV outpatient care in resource-limited settings

  1. Ana-Claire Lew Meyer1,5
  1. 1Family AIDS Care and Education Services, Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
  2. 2Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
  3. 3Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
  4. 4Division of Global HIV/AIDS Care and Treatment (USA), Centers for Disease Control and Prevention, Nairobi, Kenya
  5. 5Department of Neurology, San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Ana-Claire Lew Meyer, Department of Neurology, University of California, San Francisco, Visiting Scientist, Research, Care and Training Program, Center for Microbiology Research, Kenya Medical Research Institute, Box 614-40100, Kisumu, Kenya; meyerac{at}sfgh.ucsf.edu
  • Received 5 February 2012
  • Revised 24 September 2012
  • Accepted 27 September 2012
  • Published Online First 30 October 2012

Abstract

Purpose Cryptococcal meningitis is a leading cause of mortality among HIV-infected individuals in sub-Saharan Africa but little is known about its treatment and outcomes in decentralised HIV outpatient settings. We assessed adherence to treatment guidelines and determined predictors of survival.

Design A computerised laboratory database identified HIV-infected adults with cryptococcal meningitis at Family AIDS Care and Education Services in Nyanza Province, Kenya, between 2005–2009. Medical records were reviewed. Kaplan-Meier survival curves were generated. Bivariate and multivariate Cox proportional hazards models were used to determine associations between key clinical characteristics and survival.

Results Medical records were located for 79% (71/90). Mortality was 38% (27/71) over a median follow-up period of 201 days (IQR: 10–705 days). Adherence to local guidelines for treatment of cryptococcal meningitis was 48% (34/71). Higher body mass index was associated with improved survival (HR: 0.82, 95% CI (0.68 to 0.99)) even after controlling for factors such as age, CD4 cell count, receipt of highly active anti-retroviral therapy, and treatment with any anti-fungal therapy.

Conclusions Cryptococcal meningitis diagnosed in routine HIV outpatient settings is largely treated as an outpatient and adherence to treatment guidelines is poor. Body mass index is a critical independent predictor of outcome. Additional research to determine the most effective strategies to reduce premature mortality is urgently needed.