HIV-Positive Patients at Higher Risk of Late Mortality Following Cryptococcal Infection

Cryptococcosis continues to be one of the most common opportunistic infections and causes of mortality in patients living with HIV. Thanks to antiretroviral therapy, early overall mortality following cryptococcosis in people living with HIV has decreased considerably; however, not much is known about late mortality in patients living with the virus.

New research being presented in a Poster Abstract Session at ID Week 2018, suggests that patients living with HIV have high mortality following cryptococcal infection which persists beyond initial hospitalization. As such, the investigators stress the need to identify patients who are at increased risk of mortality in order to improve patient outcomes.

For their retrospective cohort study, the investigators analyzed demographics, clinical features, diagnostics, and outcomes of patients with HIV and cryptococcosis occurring from January 2002 to July 2017 at Barnes Jewish Hospital in St. Louis, Missouri. Death dates were collected from the hospital system’s Medical Informatics database as well as the Social Security Death Index.

The investigators analyzed 105 cases of patients with HIV and cryptococcosis; 55 of these patients (52.4%) were alive at the time of analysis, 17 died within 90 days of cryptococcal diagnosis (early mortality, 16.2%), and 33 died post-90 days (late mortality, 31.4%).

The results indicated that late mortality patients had an increased likelihood of knowing their HIV status at the time that they received their cryptococcal diagnosis (97%) compared with patients who were still alive at time of analysis (70.9%) or early mortality patients (70.6%) (P = .03).

Late mortality patients also were found to be less likely to adhere to their antiretroviral regimens (15.2%) compared with living patients (43.6%) and early mortality patients (36.3%) (P = .02). Furthermore, late mortality patients were more likely to have Medicaid (51.5%) compared with living patients (29.1%) and early mortality patients (17.6%) (P = .03) and less likely to have private insurance (6.1%) compared with those living (29.1%) and early mortality patients (17.6%) (P = .007).

The investigators noted that presenting symptoms and diagnostics were comparable between all 3 groups, and the prevalence of substance abuse (48.6%) and psychiatric history (31.4%) were determined to be high across all groups, but not significantly different.

With the advent of antiretroviral therapy, an HIV diagnosis is no longer a death sentence; however, in order to keep viral loads under control, patients must adhere to their treatment regimens. In this study, nonadherence to antiretroviral regimens was linked with a higher risk of death after cryptococcosis diagnosis.

The investigators stressed the need to identify patients who may be at higher risk of mortality in order to provide successful treatment and improve patient outcomes. They also called for more studies examining late mortality in patients with other opportunistic infections.