Clinical-laboratory features and prognostic factors of adverse clinical outcome in patients with cryptococcal meningoencephalitis and HIV infection

Abstract

One of the major tasks in the fight against the HIV epidemic in Ukraine was to provide effective care to the most severe patients with HIV-infection (PLHIV) and cryptococcal meningoencephalitis (CM). The study of clinical characteristics and predictors of adverse clinical outcomes may provide a key to improving treatment outcomes in critically ill patients.
 Purpose of the study. The aim of our study was to determine the clinical and laboratory features and prognostic factors of adverse clinical outcome in patients with cryptococcal meningoencephalitis and HIV infection.
 Material and methods. We conducted a retrospective study that included 71 adult patients with HIV-infectionand CM. Atthefirststage, astudy of socio-demographic, clinical, clinical-laboratory, immunological and virological indicators of patients from the general group was conducted. In the second stage, patients were divided into two groups. Group 1 included 26 PLHIV with fatalities. Group 2 included 45 HIV-infected patients who were discharged after completion of inpatient treatment. The baseline of the standard clinical and laboratory examination between the two groups was compared and the factors of development of adverse clinical outcome in patients with CM on the background of HIV infection were identified.
 Results and discussion. The clinical characteristics of the average HIV-infected patient with CM admitted to the inpatient department are as follows: these are young patients (average 38 years, 79% from 23 to 44), HIV was diagnosed within 10 months before the onset of the disease, with normal body mass index, predominantly sexually rout of transmission HIV (83%), who mostly had no experience of ART (87%) or took ART for 1 month (1,1 (0,33–1,93) months). These patients did not have significant gender differences (men – 53%, women – 47%), had severe immunosuppression (number of CD4 lymphocytes 23,0 (9,0–56,0) cells per μl) and high levels of viral HIV load (5,6 (4,8–6,2) log10 IU/ml). Cerebrospinal fluid examination revealed a weak level of pleocytosis (10,0 (4,0–38,0) cells per μl), which was mostly normal (27–38%) or lymphocytic (26–37%), as well as a decrease in glucose 2,3 (1,4–2,9) mmol/l and increase in protein level – 0,6 (0,3–1,0) g/l. In group 1 the share of men was significantly lower (p = 0,015) than in group 2 – 9 (34,6%) against 29 (64,4%). The level of urea in plasma, at normal values, in the group of dead patients was higher (P = 0,047) than in the group with a favorable result. In the group of fatal cases, a higher proportion of patients had disorders of consciousness (P = 0,027), dysarthria (P = 0,021) and cognitive impairment (P = 0,021). In group 2, a higher proportion of patients had initial complaints of nausea and/or vomiting (P = 0,027).
 Conclusions. Clinical and laboratory features of a patient with CM and HIV infection in Ukraine are young age, normal body mass index, sexual route of infection, lack of experience in ART, severe immunosuppression and high levels of HIV viral load. In patients with CM and HIV infection, cerebrospinal fluid examination revealed mild pleocytosis (10,0 (4,0–38,0) cells per μl), which was predominantly normal (27–38%) or lymphocytic (26–37%), decrease in glucose levels of 2,3 (1,4–2,9) mmol/l and an increase in protein levels – 0,6 (0,3–1,0) g/l. Predictors of the development of adverse clinical outcomes in patients with CM and HIV infection are females, as well as the presence of hospitalization of disorders of consciousness, dysarthria and cognitive impairment.