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.
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.
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).
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.
W. Powderly, None
C. Santos, None