{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T03:20:46Z","timestamp":1778901646482,"version":"3.51.4"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"1048","license":[{"start":{"date-parts":[[2012,10,30]],"date-time":"2012-10-30T00:00:00Z","timestamp":1351555200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Purpose<\/jats:title>\n                  <jats:p>Cryptococcal 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>A computerised laboratory database identified HIV-infected adults with cryptococcal meningitis at Family AIDS Care and Education Services in Nyanza Province, Kenya, between 2005\u20132009. 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Medical records were located for 79% (71\/90). Mortality was 38% (27\/71) over a median follow-up period of 201\u2005days (IQR: 10\u2013705\u2005days). 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Cryptococcal 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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/postgradmedj-2012-130823","type":"journal-article","created":{"date-parts":[[2012,10,31]],"date-time":"2012-10-31T01:10:31Z","timestamp":1351645831000},"page":"73-77","source":"Crossref","is-referenced-by-count":13,"title":["Predictors of outcome in routine care for Cryptococcal meningitis in Western Kenya: lessons for HIV outpatient care in resource-limited settings"],"prefix":"10.1093","volume":"89","author":[{"given":"Caroline","family":"Kendi","sequence":"first","affiliation":[{"name":"Family AIDS Care and Education Services, Center for Microbiology Research, Kenya Medical Research Institute , Nairobi, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeremy","family":"Penner","sequence":"additional","affiliation":[{"name":"Family AIDS Care and Education Services, Center for Microbiology Research, Kenya Medical Research Institute , Nairobi, Kenya"},{"name":"Department of Family Practice, University of British Columbia , Vancouver, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julius","family":"Koech","sequence":"additional","affiliation":[{"name":"Family AIDS Care and Education Services, Center for Microbiology Research, Kenya Medical Research Institute , Nairobi, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary","family":"Nyonda","sequence":"additional","affiliation":[{"name":"Family AIDS Care and Education Services, Center for Microbiology Research, Kenya Medical Research Institute , Nairobi, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Craig R","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco , San Francisco, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth A","family":"Bukusi","sequence":"additional","affiliation":[{"name":"Family AIDS Care and Education Services, Center for Microbiology Research, Kenya Medical Research Institute , Nairobi, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evelyn","family":"Ngugi","sequence":"additional","affiliation":[{"name":"Division of Global HIV\/AIDS Care and Treatment (USA), Centers for Disease Control and Prevention , Nairobi, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana-Claire Lew","family":"Meyer","sequence":"additional","affiliation":[{"name":"Family AIDS Care and Education Services, Center for Microbiology Research, Kenya Medical Research Institute , Nairobi, Kenya"},{"name":"Department of Neurology, San Francisco General Hospital, University of California San Francisco , San Francisco, California, 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