A pragmatic approach to managing antiretroviral therapy-experienced patients diagnosed with HIV-associated cryptococcal meningitis: impact of antiretroviral therapy adherence and duration
A pragmatic approach to managing antiretroviral therapy-experienced patients diagnosed with HIV-associated cryptococcal meningitis: impact of antiretroviral therapy adherence and duration
复制标题
DOI：
10.1097/qad.0000000000002556
复制
发表时间：
2020-07-15
期刊：
影响因子：
3.8
通讯作者：
Jarvis, Joseph N.
中科院分区：
文献类型：
--
作者：
Alufandika, Melanie;Lawrence, David S.;Jarvis, Joseph N.
Cryptococcal meningitis accounts for 15% of all HIV-related deaths [1]. The overall number of cryptococcal meningitis cases has remained relatively stable in many low-to-middle income countries (LMICs) despite increasing roll-out of antiretroviral therapy (ART). Increasing numbers of patients are at risk of developing cryptococcal meningitis following ART failure or discontinuation, offsetting declines in those presenting for the first time with advanced HIV [2–4]. Over half of patients diagnosed with cryptococcal meningitis in recent studies in sub-Saharan Africa are ART-experienced (ie currently receiving or previously received ART)[5, 6]. Although there is robust evidence from prospective randomized trials that ART initiation should be delayed until 4–6 weeks after starting antifungal therapy in ART-naïve cryptococcal meningitis patients [7, 8], the approach to ART management among ART-experienced cryptococcal meningitis patients lacks adequate evidence, with a paucity of published data.We are a group of clinicians and researchers from AMBIsome Therapy Induction OptimisatioN (AMBITION), a phase III randomized controlled trial exploring novel treatments for HIV-associated cryptococcal meningitis [9]. In this viewpoint, we aim to synthesize the existing literature on the management of ART-experienced cryptococcal meningitis patients and present the consensus that we have reached regarding the optimal management of these patients, an area where there remains considerable clinical uncertainty.
