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Management of HIV-Associated Cryptococcal Meningitis

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Abstract

Purpose of Review

Cryptococcal meningitis remains a significant cause of mortality among people living with HIV. This review summarizes current practices and recent advances in the management of cryptococcal meningitis.

Recent Findings

Results from recent clinical trials have improved understanding of optimal induction therapy for cryptococcal meningitis, with the most recent data supporting the use of a single high dose of liposomal amphotericin B followed by two weeks of flucytosine and fluconazole. Studies have also demonstrated significantly reduced mortality with therapeutic lumbar punctures in patients with cryptococcal meningitis. Despite advances in management, long-term mortality remains high and may continue even after completion of antifungal therapy, emphasizing the importance of immune restoration in people living with HIV.

Summary

Cryptococcal disease remains prevalent among people living with HIV, especially in resource-limited settings. Advances in treatment strategies, as well as increased accessibility to antifungal drugs, screening tests, and antiretroviral therapy, are critical for reducing morbidity and mortality from cryptococcal meningitis.

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  1. Division of Infectious Diseases, Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, 63108, USA

    Matthew R. Osborn, Andrej Spec & Patrick B. Mazi

  2. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA

    Patrick B. Mazi

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Osborn, M.R., Spec, A. & Mazi, P.B. Management of HIV-Associated Cryptococcal Meningitis. Curr Fungal Infect Rep 17, 124–131 (2023). https://doi.org/10.1007/s12281-023-00458-0

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