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Abstract：
Objective: We intend to investigate the relapse of HIV-associated cryptococcal meningitis (CM), assess potential predictors and conduct survival analysis, with a view to establishing a valid reference for the management of the relapse of CM. Method: This is a retrospective study in Chinese patients with HIV-associated CM and those who experience relapse of CM. Baseline demographic, laboratory and clinical characteristics of patients with HIV-associated CM were collected. Predictors for relapse of HIV-associated CM were analyzed using univariate and multivariate logistic regression. Survival probability in relapse cases was determined by Kaplan-Meier survival curves. Results: During the study period, 87 of 348 (25.0%) HIV patients experienced the relapse of CM. CD4+ T-cell counts, antiretroviral therapy (ART) status and the time from symptom onset to presentation were all statistically associated with the relapse of CM (p = 0.013, 0.018 and 0.042, respectively). The overall survival among 46 HIV CM relapse patients whose survival information were obtained, was 78.3%. The proportion of patients who died after antifungal treatment for CM was greater in those whose interval from symptom onset to presentation ≥4 weeks, compared with those <4 weeks (p = 0.0331). Conclusions: In order to reduce the relapse of CM and increase the survival possibility of these patients, we can promote the importance of ART before CM occurs, emphasize timely consultation when any CM-associated clinical symptoms occurs, and individualized the timing of ART initiation according to indicators which can reflect the severity of CM.
摘要：
目的：我们打算调查HIV相关隐球菌性脑膜炎（CM）的复发，评估潜在的预测因素并进行生存分析，以期为CM复发的管理建立有效的参考依据。方法：这是一项针对中国HIV相关CM患者和CM复发患者的回顾性研究。基线人口统计，收集HIV相关CM患者的实验室和临床特征。使用单变量和多变量逻辑回归分析HIV相关CM复发的预测因子。复发病例的生存概率由Kaplan-Meier生存曲线确定。结果：在研究期间，348例HIV患者中有87例（25.0%）出现CM复发。CD4+T细胞计数,抗逆转录病毒治疗(ART)状态和从症状出现到出现的时间均与CM复发相关(分别为p=0.013,0.018和0.042).获得生存信息的46例HIVCM复发患者的总生存率，为78.3%。在从症状发作到表现≥4周的患者中，CM抗真菌治疗后死亡的患者比例更大，与<4周相比（p=0.0331）。结论：为了减少CM的复发，增加这些患者的生存可能性，我们可以在CM发生之前宣传ART的重要性，强调在出现任何CM相关临床症状时及时咨询，并根据能反映CM严重程度的指标对ART启动时机进行个体化选择。
