{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T15:54:17Z","timestamp":1767369257190,"version":"3.48.0"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T00:00:00Z","timestamp":1766448000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Cryptococcal meningitis (CM) remains one of the leading causes of morbidity and mortality among people living with HIV, particularly in low and middle-income countries where access to standard antifungal therapy is limited. Despite global advances in HIV care, early diagnosis and effective treatment of cryptococcal disease continue to represent major challenges in resource-limited settings. We conducted a retrospective registry-based cohort study of HIV patients and a first episode of CM admitted to a Peruvian national referral hospital between 2005 and 2015. Cox proportional hazards models were used to identify independent variables related to 30- and 90-day mortality. A total of 83 patients were included, 87% were males with a median age (interquartile range) of 33.8 (28.7\u201345.1) years. At baseline, 27.7% of patients had received antiretroviral therapy. Mortality at 30 and 90 days was 26.5% and 31.3%, respectively. In multivariable Cox models, the limited sample availability (59 for baseline and 83 for treatment analyses), constrained the precision estimates; nevertheless, altered consciousness, hyponatremia, and headache as independent predictors of mortality [30-day Hazard Ratios (HR): 7.6 (2.2\u201326.0); 5.4 (1.6\u201318.2); 0.1 (0.02\u20130.4); and 90-day HR: 7.1 (2.0\u201326.0); 10.9 (2.8\u201341.8); 0.1 (0.02\u20130.4), respectively]. In treatment analyses, fluconazole monotherapy or the absence of antifungals were significantly associated with higher mortality [30-day HR: 2.7 (1.1\u20136.8); 21.1 (7.8\u201357.5) and 90-day HR: HR: 2.8 (1.1\u20137.3); 20.1 (7.4\u201354.5), respectively]. In resource-limited settings, mortality from HIV-associated CM remains unacceptably high. These findings underscore the urgent need to enhance early diagnostic strategies and ensure access to optimal antifungal therapy to improve survival outcomes.<\/jats:p>","DOI":"10.1093\/mmy\/myaf123","type":"journal-article","created":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T12:55:15Z","timestamp":1766494515000},"source":"Crossref","is-referenced-by-count":0,"title":["Mortality in first-episode HIV-associated cryptococcal meningitis in Peru"],"prefix":"10.1093","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3874-1432","authenticated-orcid":false,"given":"Juan Jos\u00e9","family":"Montenegro-Idrogo","sequence":"first","affiliation":[{"name":"Facultad de Ciencias de la Salud, Universidad Cient\u00edfica del Sur , Lima 15067 ,","place":["Peru"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9821-029X","authenticated-orcid":false,"given":"Luz","family":"Quispe-G\u00e1rate","sequence":"additional","affiliation":[{"name":"Facultad de Medicina San Fernando, Universidad Nacional Mayor de San Marcos , Lima 15067 ,","place":["Peru"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Blanca","family":"Salazar","sequence":"additional","affiliation":[{"name":"Servicio de Infectolog\u00eda, Instituto Nacional de Salud del Ni\u00f1o, San Borja , Lima 15037 ,","place":["Peru"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sami","family":"Alcedo","sequence":"additional","affiliation":[{"name":"Institute of Tropical Medicine , Antwerpen 2000 ,","place":["Belgica"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paola L","family":"Rondan","sequence":"additional","affiliation":[{"name":"Facultad de Medicina San Fernando, Universidad Nacional Mayor de San Marcos , Lima 15067 ,","place":["Peru"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge","family":"Ar\u00e9valo","sequence":"additional","affiliation":[{"name":"Servicio de Medicina de Enfermedades Infecciosas y Tropicales, Hospital Nacional Dos de Mayo , Lima 15003 ,","place":["Peru"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alfredo","family":"Chiappe-Gonzalez","sequence":"additional","affiliation":[{"name":"Instituto de Investigaciones en Ciencias Biom\u00e9dicas, Universidad Ricardo Palma , Lima 15039 ,","place":["Peru"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5863-0502","authenticated-orcid":false,"given":"Jaime","family":"Soria","sequence":"additional","affiliation":[{"name":"University of Kentucky , Lexington, KY 40506 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,12,23]]},"reference":[{"issue":"12","key":"2026010210512961900_bib1","doi-asserted-by":"publisher","first-page":"1748","DOI":"10.1016\/S1473-3099(22)00499-6","article-title":"The global burden of HIV-associated cryptococcal infection in adults in 2020: A modelling analysis","volume":"22","author":"Rajasingham","year":"2022","journal-title":"Lancet Infect Dis"},{"year":"2024","author":"UNAIDS","key":"2026010210512961900_bib2"},{"key":"2026010210512961900_bib3","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1007\/s40588-016-0035-5","article-title":"HIV-associated cryptococcal meningitis: Bridging the gap between developed and resource-limited settings","volume":"3","author":"Tenforde","year":"2016","journal-title":"Curr Clin Microbiol Rep"},{"journal-title":"Guidelines for Diagnosing, Preventing and Managing Cryptococcal Disease among Adults, Adolescents and Children Living with HIV","year":"2022","author":"World Health Organization","key":"2026010210512961900_bib4"},{"key":"2026010210512961900_bib5","doi-asserted-by":"publisher","first-page":"963","DOI":"10.3389\/fphar.2020.00963","article-title":"What is the most appropriate induction regimen for the treatment of HIV-associated cryptococcal meningitis when the recommended regimen is not available? 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