Impact of antiretroviral therapy on the relapse of cryptococcosis and survival of HIV-infected patients with cryptococcal infection

Background: Cryptococcosis is an opportunistic infection with morbidity and mortality in HIV-infected patients. Impact of antiretroviral therapy (ART) on the relapse of cryptococcosis and survival of HIV-infected patients with cryptococcosis has not been well established. Methods: A retrospective cohort Study of HIV-infected patients with cryptococcosis during 1997-2005 was conducted. Relapse and survival rates with corresponding risk factors were determined. Results: There were 149 patients with a mean age of 33.5 +/- 7.4 years and 57% were male. Median CD4 cell count was 22 cells/mm(3). After exclusion of patients who died or were lost to follow-up during the first two weeks, 127 patients were eligible for the analysis of the effect of ART on relapse and survival rates. Of 127 patients, 52 received ART. The demographic data between the two groups were similar. Median time of ART initiation after cryptococcal diagnosis was 2.6 months. The most frequent ART used was NNRTI-based regimen (88.4%). Median CD4 change at six months of ART was 97 cells/mm(3) and 87.9% achieved undetectable HIV-RNA. The cumulative 75% survival (free) from relapse duration was 10.4 months in no-ART group and 41.9 months in ART group (P < 0.01). The 75% survival from cryptococcal-related mortality in no-ART group was 6.4 months whereas > 54 months for ART group (P < 0.01). In Cox proportional hazards model, ART was the only factor that associated with lower relapse and mortality rate (P < 0.01). Conclusions: ART significantly reduced relapse and mortality rate from cryptococcosis in HIV-infected patients. ART is strongly recommended in this population and should not be delayed.