Quality of life and associated factors among HIV positive patients after completion of treatment for Cryptococcal meningitis
Authors: Kitonsa Jonathan , Kiwanuka Julius , Anywaine Zacchaeus , Kansiime Sheila , Katumba Kenneth , Aeron Namirembe , Beardsley Justin , Kibengo Freddie , Gray Alastair , Kaleebu Pontiano , Day Jeremy 
Published: June 2020

Background

Cryptococcal meningitis (CCM) remains one of the leading causes of mortality among HIV infected patients. Due to factors such as the severity of CCM pathology, the quality of life (QOL) of patients post-treatment is likely to be poor. Few studies have reported on QOL of CCM patients post treatment completion. We used data collected among patients in the CryptoDex trial (ISRCTN59144167) to determine QOL and associated factors at week 10 and six months from treatment initiation.

Methodology

CryptoDex was a double-blind placebo-controlled trial of adjunctive dexamethasone in HIV infected adults with CCM, conducted between 2013 and 2015 in six countries in Asia and Africa. QOL was determined using the descriptive and Visual Analog Scales (VAS) of the EuroQol Five-Dimension-Three-Level (EQ-5D-3L) tool. We derived index scores, and described these and the VAS scores at 10 weeks and 6 months; and used linear regression to determine the relationship between various characteristics and VAS scores at both time points.

Results

Of 451 patients enrolled in the trial, 238 had QOL evaluations at week 10. At baseline, their mean age (SD) was 35.2(8.5) years. The overall mean VAS score (SD) at 10 weeks was 57.2 (29.7), increasing significantly to 72(27.4) at month six (p<0.001). The overall mean VAS score (SD) at week 10 was 57.2(29.7), increasing significantly to 72(27.4) at month six, (p<0.001). At week 10, higher VAS score was associated with absence of confusion (p=0.039), greater weight (p=0.002), and being African (p<0.001). At month six, higher VAS score remained associated with African origin (p=0.019). Higher number of inpatient days was associated with worse VAS scores at 10 weeks and 6 months (p<0.001 and p=0.006 respectively).

Conclusion

QOL was good among patients that had completed therapy for CCM, but below perfect. Strategies to improve QOL among CCM survivors are required.

Lay summary

In spite of the remarkable reduction in the incidence of Cryptococcal meningitis (CCM), with increased use of antiretroviral therapy, incidence remains unacceptably high especially in sub-Saharan Africa and Asia where more than 90% of the cases and deaths occur.

Due to factors such as the severity of CCM pathology, the quality of life (QOL) of patients post-treatment is also likely to be poor. Few studies have reported on QOL of CCM patients post treatment completion. We used data collected among patients in the CryptoDex trial (ISRCTN59144167) to determine self-perceived QOL and associated factors among 238 survivors at week 10 and 203 survivors at six months from treatment initiation.

We determined QOL using the descriptive and Visual Analog Scales (VAS) of the EuroQol Five-Dimension-Three-Level (EQ-5D-3L) tool.

We found that while self-perceived QOL was only relatively good among this cohort of patients who had survived through treatment for CCM, it continued to improve over the 6 months following diagnosis. Low weight at diagnosis, prolonged hospital admission, and being Asian were associated with lower QOL. QOL is an important outcome that should be considered among HIV infected patients treated for serious infections such as CCM.