Monitoring
Careful monitoring of serum electrolytes, renal function, and bone marrow function is essential in order to recognise and treat antifungal drug toxicity.[20]
In patients without HIV, the duration of therapy is based on disease resolution, but it is usually 6-18 months.[67] There is a high risk of relapse among patients with cryptococcal meningitis who are not receiving adequate maintenance therapy. Maintenance therapy may be discontinued in people with HIV who respond to antiretroviral therapy (ART; i.e., CD4 cell counts ≥100 cells/microlitre, undetectable viral loads on ART, minimum of 1 year of azole antifungal chronic maintenance therapy after successful treatment of cryptococcosis).[20] It should be re-initiated if the CD4 count decreases to <100 cells/microlitre.[20]
Immune reconstitution inflammatory syndrome should be considered when worsening of the clinical status occurs despite adequate treatment.[20]
Use of this content is subject to our disclaimer