{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T19:19:47Z","timestamp":1790104787408,"version":"4.0.1"},"reference-count":23,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2019,10,21]],"date-time":"2019-10-21T00:00:00Z","timestamp":1571616000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","award":["R01NS086312, R25TW009345"],"award-info":[{"award-number":["R01NS086312, R25TW009345"]}],"id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/M007413\/1"],"award-info":[{"award-number":["MR\/M007413\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["T32AI055433"],"award-info":[{"award-number":["T32AI055433"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Mycoses"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Cryptococcal meningitis accounts for 15% of all AIDS mortality globally. Most cases in low\u2010 and middle\u2010income countries are treated with fluconazole monotherapy, which is associated with a high mortality. New available therapies are needed. Short\u2010course amphotericin B has been shown to be a safe and efficient therapeutic option. Sertraline has in vitro fungicidal activity against <jats:italic>Cryptococcus<\/jats:italic> and bi\u2010directional synergy with fluconazole.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted an open\u2010label clinical trial to assess the safety and efficacy of sertraline 400\u00a0mg\/day and fluconazole 1200\u00a0mg\/day (n\u00a0=\u00a028) vs sertraline, fluconazole and additional 5\u00a0days of amphotericin B deoxycholate 0.7\u20101\u00a0mg\/kg (n\u00a0=\u00a018) for cryptococcal meningitis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Two\u2010week survival was 64% (18\/28) without amphotericin and 89% (16\/18) with amphotericin, and 10\u2010week survival was 21% (6\/28) vs 61% (11\/18), respectively (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.012). The cerebrospinal fluid (CSF) <jats:italic>Cryptococcus<\/jats:italic> clearance rate was 0.264 log<jats:sub>10<\/jats:sub> colony\u2010forming units (CFU)\/mL of CSF\/day (95% CI: 0.112\u20100.416) without amphotericin and 0.473 log<jats:sub>10<\/jats:sub> CFU\/mL\/day (95% CI: 0.344\u20100.60) with short\u2010course amphotericin (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.03). Sertraline was discontinued in one participant due to side effects. Four participants receiving amphotericin B experienced hypokalemia &lt;2.4\u00a0mEq\/L.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Short\u2010course amphotericin substantially increased CSF clearance and 10\u2010week survival. Adjunctive sertraline improved 2\u2010week CSF fungal clearance but did not improve 10\u2010week mortality compared with published data using fluconazole 1200\u00a0mg\/day monotherapy (early fungicidal activity 0.15 log<jats:sub>10<\/jats:sub> CFU\/mL\/day).<\/jats:p><\/jats:sec>","DOI":"10.1111\/myc.12995","type":"journal-article","created":{"date-parts":[[2019,8,28]],"date-time":"2019-08-28T22:26:03Z","timestamp":1567031163000},"page":"1127-1132","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Short\u2010course amphotericin B in addition to sertraline and fluconazole for treatment of HIV\u2010associated cryptococcal meningitis in rural Tanzania"],"prefix":"10.1111","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6221-8409","authenticated-orcid":false,"given":"Andrew","family":"Katende","sequence":"first","affiliation":[{"name":"Chronic Diseases Clinic of Ifakara Ifakara Health Institute Ifakara Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gladys","family":"Mbwanji","sequence":"additional","affiliation":[{"name":"Chronic Diseases Clinic of Ifakara Ifakara Health Institute Ifakara Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Faini","sequence":"additional","affiliation":[{"name":"Chronic Diseases Clinic of Ifakara Ifakara Health Institute Ifakara Tanzania"},{"name":"Muhimbili University of Health and Allied sciences Dar es Salaam Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amina","family":"Nyuri","sequence":"additional","affiliation":[{"name":"Chronic Diseases Clinic of Ifakara Ifakara Health Institute Ifakara Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aneth Vedastus","family":"Kalinjuma","sequence":"additional","affiliation":[{"name":"Chronic Diseases Clinic of Ifakara Ifakara Health Institute Ifakara Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorcas","family":"Mnzava","sequence":"additional","affiliation":[{"name":"Chronic Diseases Clinic of Ifakara Ifakara Health Institute Ifakara Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine H.","family":"Hullsiek","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases &amp; International Medicine University of Minnesota Minneapolis MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Rhein","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases &amp; International Medicine University of Minnesota Minneapolis MN USA"},{"name":"Infectious Diseases Institute Makerere University Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maja","family":"Weisser","sequence":"additional","affiliation":[{"name":"Chronic Diseases Clinic of Ifakara Ifakara Health Institute Ifakara Tanzania"},{"name":"Swiss Tropical and Public Health Institute Basel Switzerland"},{"name":"University of Basel Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David B.","family":"Meya","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases &amp; International Medicine University of Minnesota Minneapolis MN USA"},{"name":"Infectious Diseases Institute Makerere University Kampala Uganda"},{"name":"School of Medicine College of Health Sciences Makerere University Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R.","family":"Boulware","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases &amp; International Medicine University of Minnesota Minneapolis MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilio","family":"Letang","sequence":"additional","affiliation":[{"name":"Chronic Diseases Clinic of Ifakara Ifakara Health Institute Ifakara Tanzania"},{"name":"Swiss Tropical and Public Health Institute Basel Switzerland"},{"name":"University of Basel Basel Switzerland"},{"name":"ISGlobal Barcelona Centre for International Health Research (CRESIB) Hospital Cl\u00ednic\u2010Universitat de Barcelona Barcelona Spain"},{"name":"Service of Infectious Diseases Hospital del Mar, Hospital del Mar Research Institute (IMIM) Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the KIULARCO Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,10,21]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e31828e1e56"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0163036"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(17)30243-8"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cit794"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1086\/507895"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001316"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1086\/593194"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1086\/649861"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1110404"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1710922"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00212-12"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(16)00074-8"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000001899"},{"key":"e_1_2_8_15_1","unstructured":"World Health Organization.Guidelines for the diagnosis prevention and management of cryptococcal disease in HIV\u2010infected adults adolescents and children: Geneva 2018."},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1312884"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/mmy\/myv104"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2011.10.014"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciu596"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0056269"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(19)30127-6"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(13)70078-1"},{"key":"e_1_2_8_23_1","volume-title":"WHO Model List of Essential Medicines","author":"World Health Organization","year":"2017"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12883-017-0878-2"}],"container-title":["Mycoses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fmyc.12995","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/myc.12995","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/myc.12995","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/myc.12995","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,8]],"date-time":"2023-09-08T17:56:03Z","timestamp":1694195763000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/myc.12995"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,21]]},"references-count":23,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2019,12]]}},"alternative-id":["10.1111\/myc.12995"],"URL":"https:\/\/doi.org\/10.1111\/myc.12995","archive":["Portico"],"relation":{},"ISSN":["0933-7407","1439-0507"],"issn-type":[{"value":"0933-7407","type":"print"},{"value":"1439-0507","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,10,21]]},"assertion":[{"value":"2019-07-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-08-23","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-10-21","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}