preprint · medRxiv
Cryptococcal meningitis remains a severe opportunistic infection among people living with HIV in Tanzania. A retrospective review of hospital records from two regional referral hospitals examined treatment approaches and outcomes between 2019 and 2024. Among patients with cryptococcal meningitis, over half were treated with fluconazole monotherapy, and overall in-hospital mortality reached 46.5 percent. However, treatment choices significantly shaped survival. Patients receiving amphotericin B-based regimens achieved an in-hospital survival rate of 83.6 percent, compared to only 19.7 percent among those treated with fluconazole monotherapy alone. Statistical analysis showed that patients given amphotericin B-based therapy were over four times more likely to survive and be discharged alive. These findings highlight that hospital practices frequently depart from recommended treatment guidelines, underlining a critical need to understand and address the barriers preventing the routine use of preferred antifungal therapies.
Cryptococcal meningitis is a dangerous complication of advanced HIV infection that carries a high risk of death. Demonstrating that amphotericin B-based treatments dramatically improve survival compared to commonly used fluconazole monotherapy provides vital evidence for healthcare providers and policymakers to update hospital practices, improve medicine procurement, and ensure life-saving guidelines are actually put into clinical effect.
The abstract does not indicate a commercialisation pathway, as it focuses on clinical outcomes, treatment adherence, and hospital-based observational data.
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Abstract Objective This study aimed to examine the prevalence, treatment practices, outcomes, and factors associated with in-hospital survival (discharged alive) among cryptococcal meningitis (CM) patients living with HIV in Tanzania. Methods This hospital-based cross-sectional study retrospectively reviewed records of people living with HIV (PLHIV) admitted to medical wards at Dodoma and Singida Regional Referral Hospitals in Tanzania from July 2019 to June 2024. Data on socio-demographics, antiretroviral therapy (ART) status, CD4 count, CM status, treatment, and outcomes were extracted using a standardised data collection tool. The primary outcome was in-hospital survival (discharged alive vs died). Descriptive statistics summarised patient characteristics, and modified Poisson regression with robust variance estimated adjusted risk ratios (aRR) for factors associated with being discharged alive. Results A total of 561 PLHIV records were reviewed. Of these, 288 (51.5%) were aged 36–55 years, 309 (55.1%) were female, and 435 (77.5%) were in WHO clinical stage IV. Overall, 159 (28.3%) patients had CM, of whom 88 (55.3%) received fluconazole monotherapy. In-hospital mortality among CM patients was 65 (46.5%). Discharge alive occurred in 61/73 (83.6%) of those on amphotericin B–based regimens versus 13/66 (19.7%) on fluconazole monotherapy. Patients treated with amphotericin B–based regimens were four times more likely to be discharged alive compared to those on fluconazole monotherapy (aPR = 4.19, 95% CI: 2.46–7.16, p < 0.001). Conclusion CM remains a major opportunistic infection among PLHIV, with most patients managed using fluconazole monotherapy. In-hospital survival was significantly higher with amphotericin B–based regimens, highlighting the need to align practice with guideline recommendations. Further qualitative research is warranted to explore barriers to implementing recommended CM treatment.
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DOI: 10.1101/2025.09.07.25335283
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