Integrated therapy for HIV and cryptococcosis

Table 1 Antifungal therapy for cryptococcosis in HIV-infected patients

Meningitis/meningoencephalitis, disseminated disease, severe pulmonary disease^a
Induction phase
Amphotericin B deoxycholate^b (0.7–1 mg/kg/day) plus flucytosine (100 mg/kg/day)	2 weeks
Alternative regimens
Amphotericin B deoxycholate (0.7–1 mg/kg/day) plus fluconazole (800 mg/day)	2 weeks
Amphotericin B deoxycholate^b (0.7–1 mg/kg/day)	4–6 weeks
Fluconazole (≥800 mg/day, preferably 1200 mg/day) plus flucytosine (100 mg/kg/day)	6 weeks
Fluconazole (800–2000 mg/day, preferably ≥1200 mg/day)	10–12 weeks
Itraconazole (400 mg/day)	10–12 weeks
Consolidation phase
Fluconazole (400 mg/day)	8 weeks
Alternative regimens
Itraconazole (400 mg/day)	8 weeks
Maintenance phase
Fluconazole (200 mg/day)	≥1 year^c
Alternative regimens
Itraconazole (400 mg/day)	≥1 year^c
Amphotericin B deoxycholate (1 mg/kg/week)	≥1 year^c
Mild-to-moderate pulmonary disease
Fluconazole (400 mg/day)	6–12 months

^aFor cerebral cryptococcoma, consider induction treatment for ≥6 weeks and consolidation and maintenance treatment for 6–18 months; for isolated cryptococcal antigenemia, consider (1) induction treatment with oral fluconazole at the dose of 800 mg/day for 2 weeks, then proceed to consolidation and maintenance treatment, or (2) oral fluconazole at the dose of 400 mg/day for 12 months
^bLiposomal amphotericin B (3–4 mg/kg/day; as high as 6 mg/kg/day) or Amphotericin B lipid complex (5 mg/kg/day) serves as an alternative to amphotericin B deoxycholate, with less nephrotoxicity and infusion reaction
^cPatients should have suppressed or very low viral load, and have CD4 counts >100 cells/μl for at least 3 months before discontinuing maintenance treatment

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