HIV-Associated Cryptococcal Meningitis: A Call for Action for New Treatment Options

  1. Samuel Okurut
  2. David B Meya

Reviewed by

Read the full article See related articles

Discuss this preprint

Start a discussion What are Sciety discussions?

Listed in

Log in to save this article

Abstract

Cryptococcal meningitis diagnosis at 62% is the leading cause of meningitis among adults with advanced HIV disease in areas with a high burden of infection. Despite attempts to improve treatment, in-hospital mortality remains unprecedentedly high. Disease complications associated with unmasking symptoms and relapse of fungal infections, delay in treatment increase the risk of individuals succumbing to cryptococcal meningitis. In this narrative review, we highlight published clinical trials evaluating the treatment of HIV-associated cryptococcal meningitis with survival as the primary endpoint. Aggregated clinical trial data show a significant decrease in survival from diagnosis to 88.5% at 2 weeks of treatment to 74% at 10 weeks of observation (p=0.001). The WHO standard of care was used as the control arm. Survival rates were similar between the control and trial arms. High in-hospital mortality remains a challenge for new survival-modifying treatments for cryptococcal meningitis. We provide evidence-based updates on cryptococcal meningitis treatment to inform new antifungal formulations or research approaches for improved outcomes. The consistency and generalizability of fungal clearance in the cerebrospinal fluid and the efficacy of antifungal drugs to clear fungi in the brain parenchyma remain unclear.

Article activity feed

  1. PREreview

    This Zenodo record is a permanently preserved version of a Structured PREreview. You can view the complete PREreview at https://prereview.org/reviews/18444011.

    Does the introduction explain the objective of the research presented in the preprint? Yes Yes, the introduction clearly explained the objective of the study with supported evidence.
    Are the methods well-suited for this research? Highly appropriate Yes, except for the omission of the subheading of the methodology.
    Are the conclusions supported by the data? Highly supported Yes, the conclusions were realistic and supported by the data.
    Are the data presentations, including visualizations, well-suited to represent the data? Highly appropriate and clear The data and results were clearly presented and are consistent with the study's findings.
    How clearly do the authors discuss, explain, and interpret their findings and potential next steps for the research? Very clearly The findings were coherently articulated, with clear implications for future research."
    Is the preprint likely to advance academic knowledge? Highly likely The preprint contributed additional perspectives on disease management.
    Would it benefit from language editing? No The language is easy to comprehend.
    Would you recommend this preprint to others? Yes, it's of high quality Apart from adding subheadings to the methodology section, no further revisions are required.
    Is it ready for attention from an editor, publisher or broader audience? Yes, as it is The authors were consistent with their review from the beginning to the end.

    Competing interests

    The author declares that they have no competing interests.

    Use of Artificial Intelligence (AI)

    The author declares that they did not use generative AI to come up with new ideas for their review.

  2. Version published to 10.20944/preprints202512.2263.v2
  3. Version published to 10.20944/preprints202512.2263.v1