Impact of Cryptococcosis on the Immune Recovery of Patients with AIDS and Severe Immunosuppression.

INTRODUCTION

Cryptococcosis is a systemic mycosis prevalent in immunosuppressed individuals, particularly those with HIV/AIDS. Immune recovery achieved through antiretroviral therapy (ART) is crucial for controlling opportunistic infections in AIDS. Given clinical observations and evidence suggesting Cryptococcus spp. accelerates HIV replication in vitro, we hypothesized that cryptococcosis may hinder immune recovery in severely immunosuppressed AIDS patients.

OBJECTIVE

To investigate the association between cryptococcosis and immune recovery in AIDS patients with severe immunosuppression (CD4 + T-cells ≤ 200 cells/mm3) after starting ART.

METHODS

From 230 consecutive patients, those followed for > 100 days were included in a matched cohort study: 21 with cryptococcosis and 67 without, matched by CD4 + T-cells range at a 3:1 ratio. Immune recovery was defined as achieving a CD4 + T-cells count ≥ 350 cells/mm3. Statistical analyses included chi-square, Fisher's exact, Mann-Whitney U tests, multivariate logistic regression, and Kaplan-Meier curves analyzed with Log Rank. A p-value < 0.05 was significant.

RESULTS

Immune recovery rates were lower in the cryptococcosis group (19.0 vs. 38.8%, p = 0.096). Multivariate analysis revealed that younger age (< 40 years), undetectable HIV viral load, and longer follow-up were independently associated with immune recovery. Patients with cryptococcosis had a 3.61-fold increased odds of immune recovery failure (95% CI 0.90-14.53; p = 0.071), approaching statistical significance.

CONCLUSION

These findings suggest that cryptococcosis may impair immune recovery in AIDS patients with severe immunosuppression. Further studies with larger cohorts are needed to confirm these results.