[Disseminated cryptococcosis in patients with AIDS. Prognostic factors of poor outcome].

BACKGROUND

The objectives of this study were to analyze the changes in the incidence of cryptococcal disease in the last 10 years (1987-1997) and to assess the factors of poor prognosis in HIV-1 infected patients.

PATIENTS AND

METHODS

Clinical records of HIV-1 infected patients diagnosed with cryptococcal infection from June 1987 to December 1997 at Hospital Clinic i Provincial in Barcelona, Spain, were examined. An univariate and multivariate analysis of the predictors of poor outcome was performed.

RESULTS

Sixty clinical records were analyzed. The number of cases per 100 exposed patients per year decreased from 1991 to 1993 and, afterwards, decreased again from 1996. Fifty patients had a resolution of clinical symptoms, 17 out of this 50 patients (34%) had a relapse. Factors associated with a higher risk of relapse were a positive blood culture and cryptococcal antigen title in cerebrospinal fluid above 1/1.024.

CONCLUSIONS

The decrease in the number of cases of cryptococcal infection coincides with the broad use of triazole antifungal drugs for oral candidiasis (1990-1991) and, afterwards, with the initiation of highly active antiretroviral therapy (1996). The best predictors of relapse are a positive blood cryptococcal culture and a high titter of cryptococcal antigen.