Comparative analysis of clinical characteristics between HIV-positive and HIV-negative patients with cryptococcal meningitis

TAO Yanping; XU Xuyun; YIN Zhengyuan; CHEN Jing; ZHANG Xiaofan

doi:10.3969/j.issn.1007-8134.2025.02.005

Abstract：Objective To investigate the clinical characteristics of cryptococcal meningitis(CM)in AIDS patients and non-human-immunodeficiency virus(HIV)infected patients.Methods A retrospective analysis was conducted on 80 CM patients admitted to the Third People's Hospital of Kunming from January 2020 to June 2021.They were divided into an HIV infected group(n=50)and a non HIV infected group(n=30)based on whether they had concurrent HIV infection.The age,gender,underlying diseases,risk factors,disease course,clinical manifestations,and laboratory indicators at the first admission of the 2 groups were compared,and the treatment methods and outcomes were compared;And compare the differences in symptoms,disease course,first lumbar puncture examination,underlying diseases,and CD4+T cell count;Compare the 30 day mortality rate with the 90 day mortality rate.All patients were followed up for 1 year.Results The CD4+T cell count in the HIV infected group was lower than that in the non HIV infected group(P＜0.05);The proportion of patients with cirrhosis,chronic kidney disease,autoimmune diseases,and malignant tumors who used glucocorticoids in the non HIV infected group was significantly higher than that in the HIV infected group,and the differences were statistically significant(P＜0.05).The time from onset to diagnosis in the HIV infected group was significantly shorter than that in the non HIV infected group(P＜0.05);The intracranial pressure,cerebrospinal fluid(CSF)white blood cells,and CSF glucose levels in the HIV infected group were lower than those in the non HIV infected group,while the incidence of cryptococcemia and the positive rate of cerebrospinal fluid culture were higher than those in the non HIV infected group,and the differences were statistically significant(P＜0.05).The results of multiple logistic regression analysis showed that CD4+T cell count,autoimmune diseases,intracranial pressure,cerebrospinal fluid white blood cells,cerebrospinal fluid glucose,and positive cerebrospinal fluid culture were independent risk factors for CM in HIV infected individuals(P＜0.05).The mortality rates at 30 and 90 days in the HIV infected group were higher than those in the non HIV infected group,and the treatment efficacy rate was lower than that in the non HIV infected group,with statistical significance(P＜0.05).Conclusion HIV infection significantly affects the clinical characteristics and outcomes of CM patients,with HIV infected individuals exhibiting more severe clinical symptoms,higher mortality rates,and poorer prognosis as the degree of immune suppression increases.