SUAB0406 | PATIENT SURVIVAL OUTCOMES FOLLOWING 7-DAY LIPOSOMAL AMPHOTERICIN B TREATMENT FOR HIV-ASSOCIATED CRYPTOCOCCAL MENINGITIS: OPERATIONAL RESEARCH FROM GUINEA, DEMOCRATIC REPUBLIC OF CONGO, AND MOZAMBIQUE

Cedric Mafu², Romao Sabuni⁶, Ibrahima Oulare³, Fodé Bangaly Sako⁸, Destin Nyalenge², Montserrat Barrios⁶, Barry Ibrahima³, Aleny Couto⁷, Gisele Mucinya², Adelard Shyaka³, Naftal Joao⁶, Pascal Mweze³, Alain Tshimungu², Rosie Burton¹, Nelesh Govender⁴, Joseph Jarvis⁵, Petros Isaakidis¹, Esther Casas¹, Jonathan Falconer¹ | ¹SAMU, Medecins Sans Frontieres, Cape Town, South Africa; ²Centre Hopital Kabinda (CHK), Medecins Sans Frontieres, Kinshasa, Democratic Republic of Congo; ³Unite Sante Formation Recherche (USFR), Medecins Sans Frontieres, Conakry, Guinea; ⁴University of Witwatersrand, Johannesburg, South Africa; ⁵London School of Hygiene and Tropical Medicine (LSHTM), London, UK; ⁶Beira Central Hospital, Medecins Sans Frontieres, Beira, Mozambique; ⁷Nacional Adjunta da Saude Publica, Maputo, Mozambique; ⁸MSHP, Conakry, Guinea

Cryptococcal meningitis is a major cause of mortality among people living with advanced HIV disease in low-resource settings. WHO guidelines recommend short-course amphotericin-based regimens to reduce toxicity while maintaining efficacy. We assessed 2- and 10-week survival outcomes following treatment with a 7-day course of liposomal amphotericin B (L-AmB) and flucytosine across three low-resource hospital settings. This prospective cohort study was conducted between 2020 and 2021 in Médecins Sans Frontières (MSF)-supported inpatient units in Guinea, the Democratic Republic of Congo (DRC), and Mozambique. Adults with HIV-associated cryptococcal meningitis were treated with 7 days of intravenous 3 mg/kg L-AmB and oral flucytosine, followed by high-dose fluconazole. Survival at 2 and 10 weeks was determined using Kaplan-Meier survival curves. A total of 158 patients were included. Median age was 40 years (IQR 33–50), 46% (72/155) were female, and median CD4 count was 58 cells/μL (IQR 25–117). The 2-week survival was 73% (110/158, 95% CI: 66–80%). The 10-week survival declined to 46% (85/158, 95% CI: 40–54%). The median time to death was 6 days (IQR 2–24), with most deaths occurring during hospitalization or in the early post-discharge period. Among those who survived to discharge, the median hospital stay was 11 days (IQR 8–14). Nosocomial infections occurred in 24% of patients during hospitalization, contributing to clinical complications and mortality. Two- and ten-week survival rates remain low compared to other opportunistic infections in advanced HIV disease. Strengthened inpatient care through effective management of raised intracranial pressure, earlier complication detection—including nosocomial infection prevention - and improved post-discharge support are needed. Randomized controlled trial data has demonstrated the single high-dose L-AmB regimen offers non-inferior mortality outcomes with reduced toxicity and the capacity for earlier discharge in research settings. This may bypass some of the drivers of high mortality identified in this study. Further operational data are required to evaluate its real-world effectiveness compared to the 7-day regimen.