HIV infection does not increase 10-week mortality of Chinese cryptococcal meningitis patients

Backgroud The role of HIV infection in precipitating different clinical features in Cryptococcal meningitis (CM) patients remains controversial. Methods One hundred and twelve CM patients living with HIV/AIDS (CM+HIV+ patients) and 112 CM patients living without HIV/AIDS (CM+HIV- patients) were enrolled after propensity score matching. Demographic characteristics, symptoms, routine blood tests, biochemical and cerebrospinal fluid (CSF) profiles were compared between the two groups. Kaplan-Meier analysis and Cox proportional hazards model was used to assess 10-week mortality. Results CM+HIV+ patients frequently occurred in young (mean age 40.3±10.5) and male (89.3%) populations who also experienced leukopenia, neutropenia, lymphocytopenia, thrombocytopenia, and hypoalbuminemia, less headaches (66.9%) and higher cryptococcemia (23.2%) (all P < 0.050); they also had higher glucose (2.6±1.1 mmol/L), increased smear positivity (78.8%) and decreased white blood cells [8.0 (2.0-28.0)×106/L] in initial CSF assay (all P< 0.050). The 10-week cumulative survival rate was 84.6% for CM+HIV+ patients and 88.5% for CM+HIV- patients (P = 0.345). Age < 35.0 years old (Hazard ratio (HR) 3.0 (1.0-8.9), P=0.046), intracranial pressure (ICP) > 250.0 mmH2O (HR: 4.8(1.1-21.6), P=0.041) and treatment lacking amphotericin B [HR: 6.5(1.9-21.4), P=0.003] were independent risk factors for 10-week mortality in CM+HIV+ patients. Conclusions There are significant clinical differences in cryptococcal meningitis patients living with or without HIV/AIDS. However, the 10-week survival rate was similar between the two groups. Younger population, high ICP and treatment lacking amphotericin B were independent risk factors for 10-week mortality of Chinese CM+HIV+ patients.