In-hospital survival of adults with HIV-associated cryptococcal meningitis in Tanzania: A retrospective comparison of amphotericin B-based regimen and fluconazole monotherapy.

Abstract

This study aimed to examine treatment modalities, outcomes, and factors associated with in-hospital survival among people with HIV (PHIV) diagnosed with cryptococcal meningitis (CM) in Tanzania. This hospital-based cross-sectional study retrospectively reviewed records of PHIV 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, 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. A total of 159 PHIV with CM records were reviewed. Of these, 89 (56.0%) were aged 36-55 years, 89 (56.0%) were female, and 138 (86.8%) were in WHO clinical stage IV. Of 159 patients, 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). CM remains a leading opportunistic infection causing high mortality among PHIV, 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.