Neurocognitive impairment in HIV-associated cryptococcal meningitis survivors remains poorly characterized. We sought to identify risk factors associated with sustained neurocognitive impairment. Cryptococcal meningitis survivors from the ASTRO-CM trial underwent neurocognitive assessment at 12 weeks. A composite quantitative neurocognitive performance score (QNPZ-8) was calculated as a mean of 8 independent z-scores.
Participants were classified by QNPZ-8 score as having mild (QNPZ-8 ≥−1), moderate (−2 < QNPZ-8 < –1), or severe (QNPZ-8 ≤−2) impairment compared with the reference cohort of HIV-negative Ugandan adults. We compared differences in baseline
demographics and clinical and laboratory variables by impairment categories.
One hundred fifty-two participants completed ≥5 of the 8 neuropsychological tests and were included in the analysis. Overall, 37% (57/152) exhibited mild (QNPZ-8 ≥−1), 37% (56/152) moderate (−2 < QNPZ-8 < –1), and 26% (39/152) severe
impairment (QNPZ-8 ≤−2). The overall mean QNPZ-8 score (SD) of −1.4 (0.82) denoted moderate neurocognitive impairment at 12 weeks. At baseline, lower weight (P = .03), Glasgow Coma Scale score <15 (P = .03), and education ≤7 years (P < .001) were more frequently observed among those with severe neurocognitive impairment at 12 weeks. Education ≤7 years (odds ratio, 6.13; 95% CI, 2.96–12.68; P < .001) and Glasgow Coma Scale score <15 (odds ratio, 2.61; 95% CI, 1.23–5.57; P = .013) were associated with moderate or severe neurocognitive impairment.