Publications by authors named "J Rhein"
Background: Neurocognitive impairment in HIV-associated cryptococcal meningitis survivors remains poorly characterized. We sought to identify risk factors associated with sustained neurocognitive impairment.
Methods: Cryptococcal meningitis survivors from the ASTRO-CM trial underwent neurocognitive assessment at 12 weeks.
Introduction: Cryptococcal meningitis remains a prominent cause of death in persons with advanced HIV disease. CSF leukocyte infiltration predicts survival at 18 weeks; however, how CSF immune response relates to CSF leukocyte infiltration is unknown.
Methods: We enrolled 401 adults with HIV-associated cryptococcal meningitis in Uganda who received amphotericin and fluconazole induction therapy.
Article Synopsis
- Access to antiretroviral therapy (ART) has improved significantly in Uganda over the past 12 years, leading to changes in the clinical presentation of HIV-associated cryptococcal meningitis.
- Between 2010 and 2022, a study analyzed three cohorts of HIV-infected individuals with cryptococcal meningitis, revealing that the most recent group (2018-2022) had a lower severity of illness and better outcomes.
- Two-week mortality rates decreased from 26% in earlier cohorts to 13% in the latest group, attributed to advances in cryptococcal screening, supportive care, and better antifungal treatments.
Cerebrospinal fluid (CSF) protein levels exhibit high variability in HIV-associated cryptococcal meningitis; however, its clinical implications remain unclear. We analyzed data from 890 adults with HIV-associated cryptococcal meningitis randomized into two clinical trials in Uganda between 2015 and 2021. CSF protein was grouped into < 100 mg/dl (72%, n = 641) and ≥ 100 mg/dl (28%, n = 249).
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- Despite available HIV treatments, cryptococcal meningitis still results in significant death rates, with the immune response's role in mortality remaining unclear.!* -
- A study of 337 Ugandan patients showed that higher levels of certain proinflammatory cytokines in their cerebrospinal fluid were linked to better survival rates, while lower levels of anti-inflammatory cytokines correlated with higher mortality.!* -
- The findings suggest that a stronger cytotoxic immune response in the central nervous system may enhance survival outcomes, highlighting the need for further research into immune responses for managing cryptococcal meningitis.!*