SAMJ: South African Medical Journal
On-line version ISSN 2078-5135
LESSELLS, Richard J; MUTEVEDZI, Portia C; HELLER, Tom and NEWELL, Marie-Louise. Poor long-term outcomes for cryptococcal meningitis in rural South Africa. SAMJ, S. Afr. med. j. [online]. 2011, vol.101, n.4, pp. 251-252. ISSN 2078-5135.
OBJECTIVES: To explore linkage to and retention in HIV care after an episode of cryptococcal meningitis (CM) in rural South Africa. DESIGN: A retrospective case series of adult individuals (>16 years old) with laboratory-confirmed CM from January - December 2007 at Hlabisa Hospital - a district hospital in northern KwaZulu-Natal. OUTCOME MEASURES: Inpatient mortality and associated risk factors were analysed. The proportion alive and on antiretroviral therapy (ART) at 2 years was determined by linkage to the HIV treatment programme. RESULTS: One hundred and four individuals were identified with laboratory diagnosis of CM; 74/104 (71.2%) with complete records were included in the analysis. Inpatient mortality was high (40.5%) and was significantly associated with reduced conscious level (aHR 3.09, 95% CI 1.30 - 7.33) and absence of headache (aHR 0.33 for headache, 95% CI 0.13 -0.87). Only 8 individuals (10.8% of all study subjects) were alive and receiving ART 2 years after the CM episode. CONCLUSIONS: Long-term outcomes of CM are poor in routine practice. Interventions to strengthen linkage to HIV treatment and care and continuation of secondary fluconazole prophylaxis are critical.