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cryptococcal meningitis
May 9, 1999

I have just found out that I have to go in for treatment of cryptococcus for the forth time in two years. When I was first diagnosed my CD4 count was 30, now it is over 300. My doctors have said that it would not come back now that my count is higher, but it has relapsed twice now with a count of over 200, Since September 1998 I have been on Itraconazole 800mg per day.(I beleive this is quite high. I have also been on Crixivan, D4T and DMP266 since January 1998. Is there any new findings about this type of meningitis and is it likley to stop relapsing.

Response from Dr. Currier

I am sorry to hear about the relapses. I agree this is rare when the CD4 count is increased above 100. I believe there is some data to suggest that fluconazole may be more effective than itraconazole for preventing relapses, but there may be a reason that itraconazole was used. I hope you are able to control the infection with re-treatment. If your viral load is not suppressed it may also be good to discuss changing antiviral therapy with your provider. I do not know if efavirenz (DMP-266) lowers itraconazole levels, it does not have any impact on fluconazole. Hope this helps. -JC


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