A 35-year-old HIV-positive man (CD4 count 45/μL, viral load 85,000 copies/mL) presents with headache, fever, and altered sensorium. CSF reveals elevated opening pressure, India ink positive, and cryptococcal antigen titre of 1:1024. Which is the preferred induction regimen for HIV-associated cryptococcal meningitis per WHO 2022 guidelines?

• A Fluconazole 400 mg/day for 8 weeks
• B Amphotericin B deoxycholate (0.7–1 mg/kg/day) + flucytosine for 2 weeks, then fluconazole
• C Itraconazole + flucytosine for 4 weeks
• D Single-dose liposomal amphotericin B (AmBisome 10 mg/kg) + flucytosine 14 days ✓

Explanation

The AMBITION trial (NEJM 2022) demonstrated that a single high dose of liposomal amphotericin B (10 mg/kg) plus 14 days of flucytosine followed by fluconazole consolidation is non-inferior to standard 2-week amphotericin B deoxycholate + flucytosine, with significantly lower nephrotoxicity. WHO 2022 guidelines recommend this single-dose AmBisome protocol as the preferred induction regimen for HIV-associated cryptococcal meningitis as it reduces infusion burden, toxicity monitoring requirements, and hospital stay compared to daily AmB deoxycholate.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.