French Neil, Gray Katherine, Watera Christine, Nakiyingi Jessica, Lugada Eric, Moore Michael, Lalloo David, Whitworth James A G, Gilks Charles F
Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK.
AIDS. 2002 May 3;16(7):1031-8. doi: 10.1097/00002030-200205030-00009.
Despite the recognition of Cryptococcus neoformans as a major cause of meningitis in HIV-infected adults in sub-Saharan Africa, little is known about the relative importance of this potentially preventable infection as a cause of mortality and suffering in HIV-infected adults in this region.
A cohort study of 1372 HIV-1-infected adults, enrolled and followed up between October 1995 and January 1999 at two community clinics in Entebbe, Uganda.
Systematic and standardized assessment of illness episodes to describe cryptococcal disease and death rates.
Cryptococcal disease was diagnosed in 77 individuals (rate 40.4/1000 person-years) and was associated with 17% of all deaths (77 out of 444) in the cohort. Risk of infection was strongly associated with CD4 T cell counts < 200 x 10(6) cells/l(75 patients) and World Health Organization (WHO) clinical stage 3 and 4 (68 patients). Meningism was present infrequently on presentation (18%). Clinical findings had limited discriminatory diagnostic value. Serum cryptococcal antigen testing was the most sensitive and robust diagnostic test. Cryptococcal antigenaemia preceded symptoms by a median of 22 days (> 100 days in 11% of patients). Survival following diagnosis was poor (median survival 26 days; range 0-138).
Cryptococcal infection is an important contributor to mortality and suffering in HIV-infected Ugandans. Improvements in access to effective therapy of established disease are necessary. In addition, prevention strategies, in particular chemoprophylaxis, should be evaluated while awaiting the outcome of initiatives to make antiretroviral therapy more widely available.
尽管新型隐球菌被认为是撒哈拉以南非洲地区艾滋病毒感染成人脑膜炎的主要病因，但对于这种潜在可预防感染作为该地区艾滋病毒感染成人死亡和痛苦原因的相对重要性，人们了解甚少。
对1372名艾滋病毒-1感染成人进行队列研究，于1995年10月至1999年1月在乌干达恩德培的两家社区诊所登记并随访。
对疾病发作进行系统和标准化评估，以描述隐球菌病和死亡率。
77人被诊断为隐球菌病（发病率为40.4/1000人年），占队列中所有死亡人数的17%（444例中的77例）。感染风险与CD4 T细胞计数<200×10⁶个细胞/升（75例患者）以及世界卫生组织（WHO）临床分期3期和4期（68例患者）密切相关。就诊时脑膜刺激征不常见（18%）。临床发现的鉴别诊断价值有限。血清隐球菌抗原检测是最敏感且可靠的诊断测试。隐球菌抗原血症比症状出现提前的中位时间为22天（11%的患者超过100天）。诊断后的生存率很低（中位生存期26天；范围0 - 138天）。
隐球菌感染是乌干达艾滋病毒感染者死亡和痛苦的重要原因。有必要改善对已确诊疾病的有效治疗的可及性。此外，在等待抗逆转录病毒治疗更广泛普及的举措结果的同时，应评估预防策略，特别是化学预防。
