Treatment
Treatment options in non-AIDS patients who have reduced immune-system function is not well studied. Intravenous Amphotericin B combined with oral flucytosine may be effective. Every attempt should be made to reduce the amount of immunosuppressive medication until the infection is resolved.
Persons living with AIDS often have a greater burden of disease and higher mortality (30-70% at 10-weeks), but recommended therapy is with Amphotericin B (0.7-1.0 mg/kg/day) and flucytosine. Where flucytosine (5FC) is not available, fluconazole 800-1200mg/day should be used adjunctively with amphotericin. Amphotericin-based induction therapy has much greater microbiologic activity than fluconazole monotherapy with 30% better survival at 10-weeks. Based on a systematic review of existing data, the most cost-effective induction treatment in resource-limited settings appears to be one week of amphotericin B 1mg/kg/day coupled with high dose fluconazole 1200mg/day. After initial treatment as above, oral fluconazole can be used. The decision on when to start treatment for HIV is not yet settled, although one small, under-powered trial (when restricting to a "per protocol analysis") suggested that delaying the start of treatment for several weeks may be beneficial in avoiding deaths from Immune reconstitution inflammatory syndrome (IRIS). A larger multisite trial, the Cryptococcal Optimal ART Timing (COAT) Trial, will be completed in spring 2013.
Read more about this topic: Cryptococcosis
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