Can Cryptococcal Meningitis Therapy be Stopped in HAART Responders?
The safety of discontinuation of CMV maintenance therapy and prophylaxis for PCP and MAI have been demonstrated in several published papers. However, whether the same holds true for suppressive therapy of cryptococcus is not known. According to an Italian study of patients with a history of cryptococcal meningitis who responded to HAART and had their anti-fungals stopped, the answer is ‘Si!’ (Abstract 546). A total of 46 patients with cryptococcal meningitis were studied. Of these 24 discontinued their anti-fungals a median of 25 months from the diagnosis of their meningitis, while the other 22 continued cryptococcal therapy. The mean CD4 cell count at the time of anti-fungal cessation was 80/cu mm and the average viral load was 2.55 log10 copies/mL. No episodes of recurrent cryptococcal meningitis occurred in either group. Serum cryptococcal antigen was detected in 5% (one patient) who stopped fungal therapy compared to 62% of those who maintained therapy. This observational, non-rand
