Li Yao, Lu Yanqiu, Nie Jingmin, Liu Min, Yuan Jing, Li Yan, Li Huan, Chen Yaokai
Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China.
Department of Hygiene Toxicology, School of Public Health, Zunyi Medical University, Zunyi Guizhou, China.
Front Med (Lausanne). 2021 May 10;8:626266. doi: 10.3389/fmed.2021.626266. eCollection 2021.
We intend to investigate the relapse of HIV-associated cryptococcal meningitis (CM), assess potential predictors and conduct survival analysis, with a view to establishing a valid reference for the management of the relapse of CM. This is a retrospective study in Chinese patients with HIV-associated CM and those who experience relapse of CM. Baseline demographic, laboratory and clinical characteristics of patients with HIV-associated CM were collected. Predictors for relapse of HIV-associated CM were analyzed using univariate and multivariate logistic regression. Survival probability in relapse cases was determined by Kaplan-Meier survival curves. During the study period, 87 of 348 (25.0%) HIV patients experienced the relapse of CM. CD4+ T-cell counts, antiretroviral therapy (ART) status and the time from symptom onset to presentation were all statistically associated with the relapse of CM ( = 0.013, 0.018 and 0.042, respectively). The overall survival among 46 HIV CM relapse patients whose survival information were obtained, was 78.3%. The proportion of patients who died after antifungal treatment for CM was greater in those whose interval from symptom onset to presentation ≥4 weeks, compared with those <4 weeks ( = 0.0331). In order to reduce the relapse of CM and increase the survival possibility of these patients, we can promote the importance of ART before CM occurs, emphasize timely consultation when any CM-associated clinical symptoms occurs, and individualized the timing of ART initiation according to indicators which can reflect the severity of CM.
我们旨在研究人类免疫缺陷病毒（HIV）相关隐球菌性脑膜炎（CM）的复发情况，评估潜在预测因素并进行生存分析，以期为CM复发的管理建立有效的参考依据。这是一项针对中国HIV相关CM患者及CM复发患者的回顾性研究。收集了HIV相关CM患者的基线人口统计学、实验室和临床特征。采用单因素和多因素逻辑回归分析HIV相关CM复发的预测因素。通过Kaplan-Meier生存曲线确定复发病例的生存概率。在研究期间，348例HIV患者中有87例（25.0%）经历了CM复发。CD4+T细胞计数、抗逆转录病毒治疗（ART）状态以及从症状出现到就诊的时间均与CM复发有统计学关联（分别为 = 0.013、0.018和0.042）。在获取生存信息的46例HIV CM复发患者中，总体生存率为78.3%。与症状出现到就诊时间<4周的患者相比，症状出现到就诊时间≥4周的患者在CM抗真菌治疗后死亡的比例更高（ = 0.0331）。为了减少CM复发并提高这些患者的生存可能性，我们可以在CM发生前宣传ART的重要性，强调出现任何与CM相关的临床症状时及时咨询，并根据能够反映CM严重程度的指标个体化ART启动时间。
