Review of Risk Factors and Factors Influencing Outcomes of Cryptococcal Meningitis in Persons Living with HIV.

Cryptococcal meningitis is a disease of public health concern that accounts for 19% of the mortality rate among individuals diagnosed with advanced HIV disease. The roll out of highly active antiretroviral therapy has significantly reduced the incidence of cryptococcal meningitis among individuals living with HIV. Nevertheless this opportunistic infection has persisted among late presenters and those who have not adhered to antiretroviral therapy (ART). Cryptococcus neoformans is the causative organism commonly identified from the cerebrospinal fluid of individuals diagnosed with HIV-related cryptococcal meningitis. As we strive to achieve zero deaths from HIV-related cryptococcal meningitis by 2030, there is a critical need to understand risk factors and factors influencing outcomes of this fatal central nervous system disease in the post-ART era. In this review we discuss the clinical, immunological-, genetic- and pathogen-related risk factors. Together with the induction phase antifungal choices and management strategies, such as therapeutic lumbar puncture, we also discuss how these factors influence mortality in individuals diagnosed with HIV-related cryptococcal meningitis secondary to Cryptococcus neoformans.