In-Hospital Survival of Adults with HIV-Associated Cryptococcal Meningitis in Tanzania: A Retrospective Comparison of Amphotericin B-based Regimen and Fluconazole Monotherapy
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Objective
This study aimed to examine the prevalence, treatment practices, outcomes, and factors associated with in-hospital survival (discharged alive) among cryptococcal meningitis (CM) patients living with HIV in Tanzania.
Methods
This hospital-based cross-sectional study retrospectively reviewed records of people living with HIV (PLHIV) admitted to medical wards at Dodoma and Singida Regional Referral Hospitals in Tanzania from July 2019 to June 2024. Data on socio-demographics, antiretroviral therapy (ART) status, CD4 count, CM status, treatment, and outcomes were extracted using a standardised data collection tool. The primary outcome was in-hospital survival (discharged alive vs died). Descriptive statistics summarised patient characteristics, and modified Poisson regression with robust variance estimated adjusted risk ratios (aRR) for factors associated with being discharged alive.
Results
A total of 561 PLHIV records were reviewed. Of these, 288 (51.5%) were aged 36–55 years, 309 (55.1%) were female, and 435 (77.5%) were in WHO clinical stage IV. Overall, 159 (28.3%) patients had CM, of whom 88 (55.3%) received fluconazole monotherapy. In-hospital mortality among CM patients was 65 (46.5%). Discharge alive occurred in 61/73 (83.6%) of those on amphotericin B–based regimens versus 13/66 (19.7%) on fluconazole monotherapy. Patients treated with amphotericin B–based regimens were four times more likely to be discharged alive compared to those on fluconazole monotherapy (aPR = 4.19, 95% CI: 2.46–7.16, p < 0.001).
Conclusion
CM remains a major opportunistic infection among PLHIV, with most patients managed using fluconazole monotherapy. In-hospital survival was significantly higher with amphotericin B–based regimens, highlighting the need to align practice with guideline recommendations. Further qualitative research is warranted to explore barriers to implementing recommended CM treatment.
