부산대학교 도서관

Objectives Anaemia represents a common toxicity with amphotericin B-based induction therapy in HIV-infected persons with cryptococcal meningitis. We sought to examine the impact of amphotericin-related anaemia on survival. Methods We used data from Ugandan and South African trial participants to characterize the variation of haemoglobin concentrations from diagnosis to 12 weeks post-diagnosis. Anaemia severity was classified based on the haemoglobin concentration at cryptococcal meningitis diagnosis, and nadir haemoglobin values during amphotericin induction. Cox proportional hazard models were used to estimate 2- and 10-week mortality risk. We also estimated 10-week mortality risk among participants with nadir haemoglobin < 8.5 g/ dL during amphotericin induction and who survived ≥ 2 weeks post-enrolment. Results The median haemoglobin concentration at meningitis diagnosis was 11.5 g/ dL [interquartile range ( IQR) 9.7-13 g/ dL; n = 311] with a mean decline of 4.2 g/ dL [95% confidence interval ( CI) −4.6 to −3.8; P < 0.001; n = 148] from diagnosis to nadir value among participants with baseline haemoglobin ≥ 8.5 g/ dL. The median haemoglobin concentration was 8.1 g/ dL ( IQR 6.5-9.5 g/ dL) at 2 weeks, increasing to 9.4 g/ dL ( IQR 8.2-10.9 g/ dL) by 4 weeks and continuing to increase to 12 weeks. Among participants with haemoglobin < 8.5 g/ dL at diagnosis, mortality risk was elevated at 2 weeks [hazard ratio ( HR) 2.7; 95% CI 1.5-4.9; P < 0.01] and 10 weeks ( HR 1.8; 95% CI 1.1-2.2; P = 0.03), relative to those with haemoglobin ≥ 8.5 g/ dL. New-onset anaemia occurring with amphotericin therapy did not have a statistically significant association with 10-week mortality ( HR 2.0; 95% CI 0.5-9.1; P = 0.4). Conclusions Amphotericin induced significant haemoglobin declines, which were mostly transient and did not impact 10-week mortality. Individuals with moderate to life-threatening anaemia at baseline had a higher mortality risk at 2 and 10 weeks post-enrolment. [ABSTRACT FROM AUTHOR]