Abstract
Cryptococcosis is an opportunistic mycotic infection often found in pigeon droppings and other bird excrement. This serious disease is often fatal and, not unexpectedly, far more common in patients with immune deficiency, including those with human immunodeficiency virus (HIV). It has been hypothesized that women with cryptococcosis and HIV have a more favorable mortality experience than men. In addition, the availability of highly active anti-retroviral therapy (ART) for HIV in the United States (US) has been associated with greater racial disparities in mortality. The US Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (WONDER) database afforded a unique opportunity to explore mortality rates due to cryptococcosis by gender and race in the US among patients with HIV from 1999 to 2016. Mortality rate ratios from cryptococcosis were significantly lower in women and whites with HIV. These descriptive data lead to the formulation of hypotheses requiring testing in analytic studies designed a priori to do so and pose clinical and public health challenges in reducing mortality from cryptococcosis in patients with HIV.
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References
Rajasingham R, Smith RM, Park BJ, et al. Global burden of disease of HIV-associated cryptococcal meningitis: an updated analysis. Lancet Infect Dis. 2017;17(8):873–81.
Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf. Accessed August 15, 2018.
Idnurm A, Lin X. Rising to the challenge of multiple Cryptococcus species and the diseases they cause. Fungal Genet Biol. 2015;78:1–6. https://doi.org/10.1016/j.fgb.2015.05.002.
Shaheen AA, Somayaji R, Myers R, Mody CH. Epidemiology and trends of cryptococcosis in the United States from 2000-2007: a population-based study. Int J STD AIDS. 2018;29(5):453–60.
Levine RS, Rust G, Pisu M, Agboto V, Baltrus P, Briggs NC, et al. Increased Black/White disparities in mortality following lifesaving innovations: a possible consequence of US federal laws. Am J Public Health. 2010 Nov;100(11):2176–84.
World Health Organization. ICD 10: International Statistical Classification of Diseases and Related Health Problems. Tenth Revision. 2nd ed. Geneva: Switzerland; 2004.
Arias E, Heron M, Hakes JK. The validity of race and Hispanic-origin reporting on death certificates in the United States: an update. National Center for Health Statistics. Vital Health Stat. 2016;1(172):1–21.
Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death: 1999-2016 on CDC WONDER Online Database, released December, 2016. Data are from the Multiple Cause of Death Files, 1999-2015, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Available at URL: http://wonder.cdc.gov/mcd-icd10.html. Accessed August 20, 2017.
Hajjeh RA, Brandt ME, Pinner RW. Emergence of cryptococcal disease; epidemiologic perspectives 100 years after its discovery. Epidemiol Rev. 1995;17(2):303–20.
McClelland EE, Hobbs LM, Rivera J, Casadevall A, Potts WK, Smith JM, et al. The role of host gender in the pathogenesis of Cryptococcus neoformans infections. PLoS One. 2013;8(5):e63632.
Hennekens CH, DeMets D. Statistical association and causation: contributions of different types of evidence. JAMA. 2011;306:1134–6.
McKenney J, Bauman S, Neary B, Detels R, et al. Prevalence, correlates, and outcomes of cryptococcal antigen positivity among patients with AIDS, United States, 1986-2012. Clin Infect Dis. 2015;60(6):959–65.
Maziarz EK, Perfect JR. Cryptococcosis. Infect Dis Clin N Am. 2016;30(1):179–206. https://doi.org/10.1016/j.idc.2015.10.006
Harris JR, Lockhart SR, Sondermeyer G, Vugia DJ, Crist MB, D’Angelo MT, et al. Cryptococcus gattii infections in multiple states outside the US Pacific Northwest. Emerg Infect Dis. 2013 Oct;19(10):1621–7.
US Centers for Disease Control and Prevention. C. neoformans infection statistics. 2015. Available at URL: https://www.cdc.gov/fungal/diseases/cryptococcosis-neoformans/statistics.html. Accessed August 29, 2019
Guidelines on the diagnosis, prevention and management of cryptococcal disease in HIV-infected adults, adolescents and children: supplement to the 2016 consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Geneva: World Health Organization; 2018. License: CC BY-NC-SA 3.0 IGO. http://apps.who.int/iris/bitstream/handle/10665/260399/9789241550277-eng.pdf;jsessionid=063F88E3D9E7F6D02A486D6BB303C15E?sequence=1
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Ms. Jaen, Dr. Drowos, and Professor Levine report no disclosures.
Professor Hennekens reported that he serves as an independent scientist in an advisory role to investigators and sponsors as Chair or Member of Data and Safety Monitoring Boards for Amgen, British Heart Foundation, Cadila, Canadian Institutes of Health Research, DalCor, Regeneron, and the Wellcome Foundation, as well as to the United States (US) Food and Drug Administration, and UpToDate; and receives royalties for authorship or editorship of 3 textbooks and as co-inventor on patents for inflammatory markers and cardiovascular disease that are held by Brigham and Women’s Hospital; and has an investment management relationship with the West-Bacon Group within SunTrust Investment Services, which has discretionary investment authority and does not own any common or preferred stock in any pharmaceutical or medical device company.
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Jaen, G., Drowos, J., Hennekens, C.H. et al. Lower Mortality Rates from Cryptococcosis in Women and Whites with Human Immunodeficiency Virus in the United States. J. Racial and Ethnic Health Disparities 7, 117–120 (2020). https://doi.org/10.1007/s40615-019-00640-6
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DOI: https://doi.org/10.1007/s40615-019-00640-6