Factors associated with survival of HIV-associated cryptococcal meningitis patients in Uganda
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The purpose of this study was to identify the factors that affect survival of Human Immunodeficiency Virus -associated cryptococcal meningitis patients. The study used Adjunctive Sertraline for Treatment of Cryptococcal Meningitis secondary data from Infectious Diseases Institute, Uganda. A sample of 429 Human Immunodeficiency Virus positive patients with the first episode of cryptococcal meningitis between August 2013 and December 2018 were followed to determine their survival. To estimate the survival function for every subgroup of each variable, the product-limit method developed by Kaplan and Meier was used and log-rank test to compare the survival functions across several groups. Lastly, an Accelerated Failure Time model was used to examine the joint effect of the covariates on duration of survival assuming a lognormal distribution for the time variable. The results showed that age, gender, weight, Cluster of Differentiation 4 count, Cerebral Spinal Fluid white blood cell count and quantitative cryptococcal culture were significant predictors for survival of Human Immunodeficiency Virus-Cryptococcal Meningitis patients. Male patients survived longer compared to female counterparts (TR=1.78, p-value=0.05). Older age was associated with shorter survival (TR=0.37, p-value=0.04). Patients weighing 50kg and more had longer survival compared to those less than 50kg (TR=1.34, p-value=0.048). CD4 count of 50 cells per µL and above was associated with increased survival (T.R=2.2, p-value=0.049). Patients with quantitative cryptococcal culture of 35000 CFU/mL and above was associated with higher mortality (TR=0.50, p-value=0.03) compared to those with less than 35000 CFU/mL. In conclusion, the risk factors for death in Human Immunodeficiency Virus -associated cryptococcal meningitis patients included, gender, age, weight, Cluster of Differentiation 4 count and fungal burden. The study recommends that government through Ministry of Health should emphasize and encourage mainly all female HIV patients aged 46 years and above to do early screening, and diagnosis of cryptococcal meningitis. This will help to identify the infected patients in their early stages of the disease and start them on the appropriate treatment regimen. The government should put in place policies for all people on ART especially those with low weight of less than 50kg to be sensitized and encouraged by Health workers to improve on their feeding. This will help their bodies to build a strong muscle and a strong immune system.