A 38-year-old HIV-positive man (CD4 28 cells/µL, viral load 120,000 copies/mL) presents with headache, fever, and photophobia. CSF shows opening pressure 28 cmH2O, lymphocytic pleocytosis, and India ink positive budding yeast. CSF cryptococcal antigen (CrAg) is positive 1:1024. The induction regimen of choice is:

• A Amphotericin B deoxycholate plus flucytosine for 2 weeks ✓
• B Fluconazole 400 mg/day for 10–12 weeks
• C Liposomal amphotericin B monotherapy for 4 weeks
• D Voriconazole for 6 weeks

Explanation

The WHO-recommended and evidence-based induction regimen for cryptococcal meningitis in HIV is amphotericin B deoxycholate 0.7–1 mg/kg/day IV plus flucytosine 100 mg/kg/day orally for 2 weeks — proven to achieve faster CSF sterilization and superior outcomes (COAT trial, ACTA trial) compared to amphotericin alone or fluconazole alone. After induction, consolidation with fluconazole 400 mg/day for 8 weeks, then maintenance (secondary prophylaxis) 200 mg/day. Intracranial pressure management with serial lumbar punctures is equally critical.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.