Jackson 2012.
Methods |
Study type: unblinded RCT Setting: 1 referral hospital in Malawi |
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Participants |
Inclusion criteria: HIV infected; ART‐naive; diagnosed by CSF India ink confirmed by CrAg test or culture or by CSF CrAg test Exclusion criteria: pregnant or breastfeeding; previous cryptococcal meningitis; ALT > 1200 IU/L; ANC < 500 x 106/L; platelets < 50 x 106/L; contraindication to any study medication Number randomized: 43 (3 excluded after randomization for false‐positive India ink) Age: median 35 years Gender: 65% male CD4 T‐cell count: median 41 cells/μL Baseline ART: none (excluded if prior ART) Baseline GCS/AMS: GCS < 15 in 25% of participants |
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Interventions |
Intervention 1: AmBd 1.0 mg/kg/day for 1 week and fluconazole 1200 mg/day for 2 weeks 2: AmBd 1.0 mg/kg/day for 1 week and fluconazole 1200 mg/day and flucytosine 100 mg/kg/day for 2 weeks Consolidation: fluconazole 800 mg/day for 2 weeks, then 400 mg/day for 8 weeks, then 200 mg/day maintenance dose Postdiagnosis ART: ART initiated at 4 weeks. Lumbar puncture schedule: scheduled on days 1, 3, 7, and 14 and as clinically indicated Laboratory monitoring: CBC, ALT, AST, K, Cr 3 times per week for first 2 weeks |
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Outcomes |
Primary outcome
Secondary outcomes
Outcome assessment schedule: daily while hospitalized, then scheduled for visit at 4 weeks to initiate ART, then followed until 10 weeks |
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Notes |
Date of study: 2009 to 2010 Funding: Medical Research Council (UK); Department for International Development in Malawi (UK) Declaration of conflict of interest by authors: none reported. |
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Risk of bias | ||
Bias | Authors' judgement | Support for judgement |
Random sequence generation (selection bias) | Low risk | 1:1 randomization stratified by GCS < 15 using random computer‐generated list |
Allocation concealment (selection bias) | Unclear risk | Not specified |
Blinding of participants and personnel (performance bias) All outcomes | High risk | Treatment was not blinded. |
Blinding of outcome assessment (detection bias) All outcomes | High risk | Outcomes unblinded by assessors |
Incomplete outcome data (attrition bias) All outcomes | Low risk | Vital status known for most participants (39/40) at 10 weeks |
Selective reporting (reporting bias) | Low risk | Authors reported on all primary and secondary outcomes. |
Other bias | Low risk | None noted. |