• Caroline Kendi, Jeremy Penner, Julius Koech, Mary Nyonda, Craig R Cohen, Elizabeth A Bukusi, Evelyn Ngugi, and Ana-Claire Lew Meyer.
• Department of Neurology, University of California, San Francisco, Visiting Scientist, Research, Care and Training Program, Center for Microbiology Research, Kenya Medical Research Institute, Box 614-40100, Kisumu, Kenya.
• Postgrad Med J. 2013 Feb 1; 89 (1048): 73-7.

PurposeCryptococcal meningitis is a leading cause of mortality among HIV-infected individuals in sub-Saharan Africa but little is known about its treatment and outcomes in decentralised HIV outpatient settings. We assessed adherence to treatment guidelines and determined predictors of survival.DesignA computerised laboratory database identified HIV-infected adults with cryptococcal meningitis at Family AIDS Care and Education Services in Nyanza Province, Kenya, between 2005-2009. Medical records were reviewed. Kaplan-Meier survival curves were generated. Bivariate and multivariate Cox proportional hazards models were used to determine associations between key clinical characteristics and survival.ResultsMedical records were located for 79% (71/90). Mortality was 38% (27/71) over a median follow-up period of 201 days (IQR: 10-705 days). Adherence to local guidelines for treatment of cryptococcal meningitis was 48% (34/71). Higher body mass index was associated with improved survival (HR: 0.82, 95% CI (0.68 to 0.99)) even after controlling for factors such as age, CD4 cell count, receipt of highly active anti-retroviral therapy, and treatment with any anti-fungal therapy.ConclusionsCryptococcal meningitis diagnosed in routine HIV outpatient settings is largely treated as an outpatient and adherence to treatment guidelines is poor. Body mass index is a critical independent predictor of outcome. Additional research to determine the most effective strategies to reduce premature mortality is urgently needed.

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