Update on Cryptococcal Disease in HIV-Infected Patients - Lecture 7

Explore an in-depth update on cryptococcal disease in HIV-infected patients presented by Graeme Meintjes from the University of Cape Town. Delve into the burden of cryptococcal meningitis in South Africa, examining laboratory-confirmed cases and case fatality rates. Learn about the CrAg Lateral Flow Assay and its implementation challenges. Analyze the ORCAS trial and WHO Guidelines from 2011. Investigate the COAT trial, which studied optimal ART timing in cryptococcal meningitis patients. Examine causes of death and the potential risks of early ART initiation. Gain insights into CSF findings and draw important conclusions about managing cryptococcal disease in HIV patients.

Intro
Overview
Laboratory-confirmed cryptococcosis in SA GERMS
Burden of cryptococcal meningitis (Gauteng Province)
Case fatality rate: South Africa
CrAg Lateral Flow Assay
Implementation and challenges
ORCAS trial
Open label RCT in Vietnam (n = 299)
WHO Guidelines 2011
Case scenario
IRIS meta-analysis
Trials of ART timing in cryptococcal meningitis prior to the COAT trial
Randomized Strategy Trial Cryptococcal Optimal ART Timing (COAT) Trial Uganda and South Africa
COAT Trial Treatment for Cryptococcal Meningitis
Causes of death
Early ART initiation particularly harmful if
What was cause of excess mortality with early ART in COAT/Zimbabwe trial?
Day 14 CSF findings
Conclusions (1)
Conclusions (2)
Acknowledgements