密切监测血清电解质、肾功能和骨髓功能非常重要,可识别和治疗抗真菌药物毒性。
在HIV阴性的患者中,治疗的疗程根据病灶的吸收程度而决定,通常在6-18个月。[39]Perfect JR, Dismukes WE, Dromer F, et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2010;50:291-322.http://cid.oxfordjournals.org/content/50/3/291.longhttp://www.ncbi.nlm.nih.gov/pubmed/20047480?tool=bestpractice.com未经过充分维持治疗的隐球菌性脑膜炎的患者,复发率高。HIV阳性患者经高效抗逆转录病毒治疗(Highly active antiretroviral treatment,HAART)后应答良好(即CD4细胞计数≥100个细胞/微升,HAART治疗>3个月时病毒载量低于检测下限,成功治疗隐球菌病后唑类抗真菌药长期维持治疗至少1年)时,可终止维持治疗。[11]Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. November 2016. http://aidsinfo.nih.gov (last accessed 19 December 2016).https://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf如果 CD4 细胞计数下降至<100 个细胞/μL,应重新开始维持治疗。[11]Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. November 2016. http://aidsinfo.nih.gov (last accessed 19 December 2016).https://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf
尽管治疗适当,但临床状态仍在恶化时,应考虑免疫重建炎性反应综合征(Immune reconstitution inflammatory syndrome,IRIS)。