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Cryptococcal meningitis in HIV — DTM&H MCQ

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ModerateHIV in TropicsCryptococcal meningitis in HIVDTM&H

A 28-year-old HIV-positive woman in Tanzania with CD4 45 presents with headache and neck stiffness. CSF shows elevated opening pressure and India ink reveals encapsulated yeasts. What is the most appropriate induction therapy?

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Correct answer: E — IV amphotericin B deoxycholate plus oral flucytosine for 1 week

Cryptococcal meningitis requires induction with IV amphotericin B plus flucytosine for 1 week (updated WHO 2022 short-course per AMBITION-cm trial). Then consolidation fluconazole 800 mg for 8 weeks, maintenance 200 mg daily. Fluconazole monotherapy induction is inferior. ART should be delayed 4-6 weeks to reduce IRIS risk.

Reference: WHO Cryptococcal Guidelines 2022; AMBITION-cm trial