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Epidemiology of HIV-associated cryptococcosis in France (19852001): comparison of the pre- and post-HAART eras

Dromer, Françoisea; Mathoulin-Pélissier, Simoneb; Fontanet, Arnaudc; Ronin, Olivierd; Dupont, Bertrandd; Lortholary, Oliviera,d; on behalf of the French Cryptococcosis Study Group

Epidemiology & Social

Objective: To analyse the epidemiological evolution of cryptococcosis in France after the introduction of highly active antiretroviral therapy (HAART).

Design: Retrospective study of cryptococcosis cases recorded at the National Reference Center for Mycoses in France since 1985.

Methods: Using the national surveillance data, we reviewed 1644 cases of HIV-associated cryptococcosis diagnosed in France (population, 59 million) between 1985 and 2001 and compared them to 335 cases recorded in HIV-negative patients.

Results: The total number of cryptococcosis cases evolved in parallel to that recorded for HIV-infected patients. Changes occurring after HAART introduction were analysed. A negative binomial regression model established a 46% decrease of the incidence of cryptococcosis during the post-HAART era (1997–2001, n = 292) compared to the pre-HAART era (1985–1996, n = 1352). According to multivariate analysis, African origin, older age, heterosexual HIV contamination, no previous AIDS-defining illness, and no previous HIV infection diagnosis were variables independently associated with an increased risk of cryptococcosis during the post-HAART era. During the same period, the characteristics of the HIV-negative population did not change.

Conclusions: Our analysis of the national surveillance identified demographic factors associated with an increased risk of cryptococcosis in the post-HAART era suggesting that failure to consult and considering oneself not at risk were determinant in the current epidemiology of HIV-related cryptococcosis in France.

From the aCentre National de Référence Mycologie et Antifongiques, Unité de Mycologie Moléculaire, Institut Pasteur, Paris, bService de Biostatistique, Institut Bergonié, Bordeaux, cUnité d'Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, and dService de Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Paris, France. *See Appendix.

Correspondence to F. Dromer, Centre National de Référence Mycologie et Antifongiques, Unité de Mycologie Moléculaire, Institut Pasteur, 25 rue du Dr. Roux, 75724 Paris Cedex 15, France.

Received: 3 July 2003; revised: 15 September 2003; accepted: 29 September 2003.

© 2004 Lippincott Williams & Wilkins, Inc.