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Zambian Study Finds Longer Breastfeeding Best for HIV-Infected Mothers

Syphilis Survey Reveals Need for Accurate Testing for Early Infection

15 February 2004

Volume 38, Number 4
Clinical Infectious Diseases 2004;38:565–571
© 2004 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2004/3804-0015$15.00
DOI: 10.1086/381261
HIV/AIDS MAJOR ARTICLE

Discontinuation of Maintenance Therapy for Cryptococcal Meningitis in Patients with AIDS Treated with Highly Active Antiretroviral Therapy: An International Observational Study

Cristina Mussini,1

Patrizio Pezzotti,3

José M. Miró,9

Esteban Martinez,9

Juan Carlos Lopez Bernaldo de Quiros,11

Paola Cinque,6

Vanni Borghi,1

Andrea Bedini,1

Pere Domingo,10

Pedro Cahn,14

Philippe Bossi,12

Andrea De Luca,4

Antonella d’Arminio Monforte,7

Mark Nelson,13

Nneka Nwokolo,13

Silvia Helou,15

Ricardo Negroni,15

Gaia Jacchetti,8

Spinello Antinori,7

Adriano Lazzarin,6

Andrea Cossarizza,2

Roberto Esposito,1

Andrea Antinori,5 and

Judith A. Aberg16 for

the International Working Group on Cryptococcosis

1Clinic of Infectious and Tropical Diseases, University of Modena and Reggio Emilia, Azienda Policlinico, and 2Department of Biomedical Sciences, University of Modena and Reggio Emilia, Modena, 3Istituto Superiore di Sanità, and 4Clinic of Infectious Diseases, Catholic University, and 5National Institute for Infectious Diseases “L. Spallanzani,” Rome, and 6Clinic of Infectious Diseases, Università Vita e Salute, and 7Clinic of Infectious Diseases, University of Milan and 8Department of Infectious Diseases, Sacco Hospital, Milan, Italy; 9Idibaps‐Hospital Cliníc, University of Barcelona and 10Hospital de la Santa Creu i Sant Pau, Barcelona, and 11Infectious Diseases Unit, Hospital Gregorio Marañon, Madrid, Spain; 12Department of Infectious Diseases, Groupe Hospitalier Pitié‐Salpêtrière, Paris, France; 13Chelsea and Westminster Hospital, London, United Kingdom; 14Clinic of Infectious Diseases, Hospital J. A. Fernandez, and 15Infectious Disease Hospital “F. J. Muñiz,” Buenos Aires, Argentina; and 16Department of Internal Medicine, Division of Infectious Disease, Washington University, St. Louis, Missouri

We conducted a retrospective, multicenter study evaluating the safety of discontinuing maintenance therapy for cryptococcal meningitis after immune reconstitution. Inclusion criteria were a previous definitive diagnosis of cryptococcal meningitis, a CD4 cell count of >100 cells/μL while receiving highly active antiretroviral therapy (HAART), and the subsequent discontinuation of maintenance therapy for cryptococcal meningitis. The primary end point was relapse of cryptococcal disease. As of July 2002, 100 patients were enrolled. When maintenance therapy was discontinued, the median CD4 cell count was 259 cells/μL and the median plasma virus load was <2.30 log10 copies/mL, and serum cryptococcal antigen was undetectable in 56 patients. During a median follow‐up period of 28.4 months (range, 6.7–64.5; 262 person‐years), 4 events were observed (incidence, 1.53 events per 100 person‐years; 95% confidence interval, 0.42–3.92). Three of these patients had a CD4 cell count of >100 cells/μL and a positive serum cryptococcal antigen test result during the recurrent episode. In conclusion, discontinuation of maintenance therapy for cryptococcal meningitis is safe if the CD4 cell count increases to >100 cells/μL while receiving HAART. Recurrent cryptococcal infection should be suspected in patients whose serum cryptococcal antigen test results revert back to positive after discontinuation of maintenance therapy.

Received 8 May 2003; accepted 2 October 2003; electronically published 29 January 2004.

Reprints or correspondence: Dr. Cristina Mussini, Clinic of Infectious and Tropical Diseases, University of Modena and Reggio Emilia, Azienda Policlinico, Via del Pozzo, 71‐ 41100 Modena, Italy ().

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  • Presented in part: 10th Conference on Retroviruses and Opportunistic Infections, Boston, Massachusetts, 10–14 February 2003 (abstract 799).

  • Financial support: Red Temática Cooperativa de Investigación en Sida del FIS (Red de Grupos 173) and Programma Nazionale di Ricerca sull’AIDS–Istituto Superiore di Sanità (Progetto Infezioni Opportunistiche e TBC derivanti dall’AIDS; grant 50D.22 to C.M.). J.M.M. was a recipient of a research grant from the Institut d'Investigacions Biomèdiques August Pi i Sunyer.

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