Individuals infected with HIV developing cryptococcal meningitis with CD4 counts ≥100 cells/mcL presented more frequently with altered mental status despite having 10-fold lower fungal burden and with greater Th2 (IL-13) immune response, a new study found. 736 participants were enrolled from 2 prospective cohorts from November 2010 to May 2017. Researchers compared those with CD4 <50, 50‒99, or ≥100 cells/mcL by clinical characteristics, CSF parameters, and 18-week survival. They found:
- Among first episode of cryptococcosis, 9% presented with CD4 ≥100 cells/mcL.
- Participants with CD4 ≥100 cells/mcL presented more often with altered mental status, despite a 10-fold lower initial median CSF fungal burden.
- Those with CD4 ≥100 cells/mcL also had higher median CSF levels of interferon-gamma, interleukin (IL)-6, IL-8, and IL-13, and lower monocyte chemokine, CCL2.
- Death within 18 weeks occurred in 47% of participants with CD4 <50, 35% with CD4 50‒99, and 40% of CD4 ≥100 cells/mcL.
Tugume L, Rhein J, Hullsiek KH, et al. HIV-associated cryptococcal meningitis occurring at relatively higher CD4 counts. [Published online ahead of print October 16, 2018]. J Infect Dis. doi:10.1093/infdis/jiy602.