Combination Versus Monotherapy for the Treatment of HIV Associated Cryptococcal Meningitis

Abstract

Objective: To study the efficacy of anti Cryptococcal treatment by cerebrospinal fluid (CSF) fungal negativity after two weeks of treatment with amphotericin B alone or combined with fluconazole in treatment of HIV associated Cryptococcal meningitis (CM). Materials and Methods: A total of 84 human immunodeficiency virus (HIV) associated CM patients confirmed by CSF culture positivity were recruited for the study. Patients were randomly divided into two groups. Group A was given amphotericin B alone whereas Amphotericin B in combination with fluconazole was given in group B for the treatment of CM. Patients were followed for 14 days. Results: Maximum number of patients was in the age group 21-49 y. All the 84 patients had <100 CD4 counts/μl. After 14 days of the treatment in group A and B, there was no significant difference in terms of fever, headache and neck stiffness as a clinical outcome. But in group B there was improved in altered sensorium and focal neurological deficit as compared to group A. After 14 days of the treatment CSF culture negativity was more in group B as compared to group A. Conclusion: Amphotericin B in combination with fluconazole is recommended for the treatment of HIV associated CM.

Keywords

• amphotericin b
• combination therapy
• cryptococcal meningitis
• fluconazole
• hiv