1686. The Changing Epidemiology of Cryptococcal Disease a Retrospective Population-Based Study
Session: Poster Abstract Session: HIV: Other Opportunistic Infections in HIV
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • Crypto2poster_final.pdf (472.9 kB)
  • Background:

    Recent trends indicate an increase in proportion of patients with Cryptococcal Disease (CD) without HIV. We aim to describe the epidemiology of CD in the post-ART era using a large representative sample.

    Methods:

    We assembled a large cohort of patients with CD using ICD-9 billing data from HCUP State Inpatient Databases of Florida (2006-2012), New York (2006-2011) and California (2004-2010).  Demographics, comorbidities, HIV status and death during hospitalization were identified. Cox proportional hazard multivariate analysis identified risk factors for death.

    Results:

    Amongst 4109 patients with CD, 50.9 %( n=2091) had HIV and 49.1 %( n=2018) were non-HIV.  Trends over time indicate that among patients with CD the proportion without HIV as a risk factor now exceeds that in HIV infected patients (Fig 1). HIV- infected patients were significantly younger (mean 42.8 vs 58.2 years) (p <0.001).  Cryptococcal meningitis was identified in 36.4% in the non-HIV group and in 69% in the HIV group. Mortality was significantly higher in the non-HIV group; 33% (n=666) vs 24.9 % (n=522) in the HIV group (p <0.001) (Fig 2).  Independent risk factors for death in the non-HIV group were advancing age, liver disease, renal failure and hematological malignancies (Table).

    Conclusion:

    Patients without HIV now account for the majority with cryptococcal infections. Cryptococcal disease in the non-HIV population is associated with significantly higher mortality compared to patients with HIV.

    Ige George, MD, Infectious Disease, Washington University School of Medicine, St Louis, MO, Andrej Spec, MD, Infectious Disease, Washington University, St Louis, MO, William Powderly, MD, FIDSA, Infectious Diseases, Washington University School of Medicine, Saint Louis, MO and Carlos Santos, MD, Medicine, Washington University School of Medicine, St. Louis, MO

    Disclosures:

    I. George, None

    A. Spec, None

    W. Powderly, None

    C. Santos, None

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