Prognosis of fungal infection of central nervous system in HIV-infected patients: a retrospective study of 77 patients in Ukraine

Lytvyn, Kateryna Y. and Shostakovych-Koretskaya, Liudmyla R. and Doroshenko, Anna A. and Andreeva, Tatiana I. (2019) Prognosis of fungal infection of central nervous system in HIV-infected patients: a retrospective study of 77 patients in Ukraine. HIV & AIDS Review, V. 18 (N 2). pp. 92-99.

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Introduction: We aimed to describe the epidemiological, clinical, laboratory characteristics, and out-comes of central nervous system (CNS) mycosis in patients with human immunodeficiency virus (HIV) and to determine characteristics associated with a higher risk of death. Retrospective data from 77 case histories of HIV-infected patients with neurological symptoms caused by various fungi including Can-dida and Cryptococcus in Dnipro, Ukraine, were analysed as a case-control study with 40 deceased indi-viduals considered as cases and 37 patients with favourable outcome (survivors) considered as controls.Material and methods: Fungi in cerebrospinal fluid (CSF) were detected with traditional culture methods. Multivariate analysis used (1) binary logistic regression with survivor/dead as a dependent variable and (2) a classification and regression tree (CRT method). Results: A combination of fungal infection with other infections of CNS (dual and triple coinfec-tion) was diagnosed in most cases (n = 53, 68.8%), while the proportion of co-infection was some-what lower among survivors (59.5%). Clinical manifestations were non-specific. Risk of death was higher among those with tuberculosis (AOR = 2.7, 95% CI: 1.0-7.5) and lower among those infect-ed with Epstein-Barr virus (EBV) (AOR = 0.3, 95% CI: 0.1-1.0) and among patients on ART (AOR = 0.2, 95% CI: 0.1-0.8). Risk of death significantly decreased over time. The classification tree shows that among HIV-mycosis neurological patients not on ART with tuberculosis, the risk of death constituted 75%, while among patients on ART with EBV-infection, all patients survived.Conclusions: Opportunistic mycoses remain an important clinical challenge among immuno-compro-mised patients especially those who were diagnosed with HIV late, failed to get antiretroviral therapy, and developed tuberculosis.

Item Type: Article
Additional Information:
Uncontrolled Keywords: opportunistic mycoses, central nervous system diseases, fatal outcome, coinfection, candidia-sis, HIV, antiretroviral therapy, opportunistic infections.
Subjects: HIV infection
Divisions: Departments > Department of Infectious Diseases
Depositing User: Анастасия Жигар
Date Deposited: 20 Jan 2021 12:06
Last Modified: 17 May 2021 10:15

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