Date Published: January 7, 2010
Publisher: Public Library of Science
Author(s): Josephine V. J. Lightowler, Graham S. Cooke, Portia Mutevedzi, Richard J. Lessells, Marie-Louise Newell, Martin Dedicoat, Dana Davis. http://doi.org/10.1371/journal.pone.0008630
Abstract: Cryptococcal meningitis (CM) remains a leading cause of death for HIV-infected individuals in sub-Saharan Africa. Improved treatment strategies are needed if individuals are to benefit from the increasing availability of antiretroviral therapy. We investigated the factors associated with mortality in routine care in KwaZulu-Natal, South Africa.
Partial Text: Despite the increasingly widespread availability of highly active antiretroviral therapy (HAART) throughout sub-Saharan Africa, HIV remains the leading cause of death amongst adults in many populations, particularly in rural Southern Africa  Prior to the availability of antiretrovirals, cryptococcal meningitis (CM) accounted for a significant proportion of deaths in HIV infected individuals – and even with increasing availability of HAART, recent data suggests that CM may account for more deaths amongst HIV positive individuals in sub-Saharan Africa than tuberculosis .
This study was carried out at Ngwelezane hospital, a 550 bed regional government hospital in Northern KwaZulu-Natal, South Africa. KwaZulu-Natal is the South African province worst affected by HIV with an estimated 1.5 million infected individuals . The hospital offers both district and regional services. 440,000 people fall under the hospital’s district catchment area, only patients from this area were included in the study as for patients referred from other hospitals it was not possible to get baseline information.
Overall 92/186 (49.5%) individuals were male with a median age of 33.5 years (IQR 28–39.5). The median age for women was 30.5 years (IQR 27–36), significantly lower than for men (P = 0.019). Baseline characteristics are shown in Table 1.
Cryptococcal disease remains an important cause of mortality particularly in sub-Saharan Africa, despite the increasing availability of antiretrovirals. We describe a prospective series of individuals within a single health care setting operating within the public health sector of South Africa. The strengths of this data are that it is a large series, representative of outcomes in routine practice within South Africa.