Predictors of neurocognitive outcomes on antiretroviral therapy after cryptococcal meningitis: A prospective cohort study

Renee Donahue Carlson, Melissa A. Rolfes, Kate E. Birkenkamp, Noeline Nakasujja, Radha Rajasingham, David B. Meya, David R. Boulware

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

Abstract

Cryptococcal meningitis is the most common cause of adult meningitis in Africa, yet neurocognitive outcomes are unknown. We investigated the incidence and predictors of neurologic impairment among cryptococcal survivors. HIV-infected, antiretroviral-naive Ugandans with cryptococcal meningitis underwent standardized neuropsychological testing at 1, 3, 6, and 12 months. A quantitative neurocognitive performance z-score (QNPZ) was calculated based on population z-scores from HIV-negative Ugandans (n=100). Comparison was made with an HIV-infected, non-meningitis cohort (n=110). Among 78 cryptococcal meningitis survivors with median CD4 count of 13 cells/μL (interquartile range: 6-44), decreased global cognitive function occurred through 12 months compared with the HIV-infected, non-cryptococcosis cohort (QNPZ-6 at 12 months, P=0.036). Tests of performance in eight cognitive domains was impaired 1 month after cryptococcal diagnosis; however, cryptococcal meningitis survivors improved their global neurocognitive function over 12 months with residual impairment (mean z-scores<-1), only in domains of motor speed, gross motor and executive function at 12 months. There was no evidence that neurocognitive outcome was associated with initial demographics, HIV parameters, or meningitis severity. Paradoxically, persons with sterile CSF cultures after 14 days of induction amphotericin therapy had worse neurocognitive outcomes than those still culture-positive at 14 days (P=0.002). Cryptococcal meningitis survivors have significant short-term neurocognitive impairment with marked improvement over the first 12 months. Few characteristics related to severity of cryptococcosis, including Cryptococcus burden, were associated with neurocognitive outcome.

Original languageEnglish (US)
Pages (from-to)269-279
Number of pages11
JournalMetabolic Brain Disease
Volume29
Issue number2
DOIs
StatePublished - Jun 2014

Keywords

  • AIDS
  • Cerebrospinal fluid
  • Cryptococcal meningitis
  • Intellectual disability
  • Neurobehavioral manifestations
  • Neurologic manifestations
  • Patient outcome assessment

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