Publications by authors named "L Tugume"
Given extensive improvements in access to antiretroviral therapy (ART) over the past 12 years, the HIV and cryptococcal meningitis landscapes have dramatically changed since 2010. We sought to evaluate changes in clinical presentation and clinical outcomes of people presenting with HIV-associated cryptococcal meningitis between 2010 and 2022 in Uganda. We analyzed three prospective cohorts of HIV-infected Ugandans with cryptococcal meningitis during 2010-2012, 2013-2017, and 2018-2022.
View Article and Find Full Text PDFCerebrospinal 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).
View Article and Find Full Text PDFArticle Synopsis
- 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.!*
Background: In 2022, the World Health Organization (WHO) recommended a single 10mg/kg dose of liposomal amphotericin B in combination with 14 days of flucytosine and fluconazole (AMBITION-cm regimen) for induction therapy of HIV-associated cryptococcal meningitis, based on the results of the multisite AMBITION-cm trial. We evaluated outcomes after real-world implementation of this novel regimen in Uganda.
Methods: We enrolled Ugandan adults with cryptococcal meningitis into an observational cohort receiving the AMBITION-cm regimen with therapeutic lumbar punctures in routine care during 2022-2023.
Article Synopsis
- Cryptococcal meningitis is a significant cause of mortality in individuals with late-stage HIV, and the relationship between cerebrospinal fluid (CSF) immune responses and leukocyte infiltration's impact on survival is being studied.
- A study involving 401 adults in Uganda showed that those with a higher CSF leukocyte count (≥50/μL) had a 68% survival rate at 18 weeks, compared to 52% for those with lower counts, indicating that immune response is critical for survival.
- Increased survival correlates with elevated levels of specific immune markers, including T helper cytokines and certain chemokines, suggesting that a robust immune response in CSF is vital for improving outcomes in patients with HIV