Clinical Implications of Refined CD4+ T-Lymphocyte Count Stratification for 30-Day and 180-Day Mortality in HIV-Associated Pulmonary Cryptococcosis.

OBJECTIVE:To evaluate the association between refined CD4+ T-lymphocyte count stratification and 30-day and 180-day all-cause mortality in human immunodeficiency virus (HIV)-associated pulmonary cryptococcosis (PC), thereby supporting risk stratification and treatment optimisation. STUDY DESIGN:A descriptive analytical study. Place and Duration of the Study: Department of Respiratory and Critical Care Medicine, Beijing Youan Hospital, Capital Medical University, Beijing, China, from September 2020 to June 2025. METHODOLOGY:Ninety-eight patients with HIV-associated PC were stratified into four groups by baseline CD4+ T-lymphocyte counts, with mortality at 30 and 180 days as the primary outcomes. Kaplan-Meier analysis and multivariable and piecewise Cox regression were used to assess the association between CD4+ T-lymphocyte count stratification and mortality, with discrimination evaluated using the area under the curve (AUC) of the receiver operating characteristic curve (ROC) and Brier scores. Statistical analyses were performed using SPSS, R software, and GraphPad Prism. RESULTS:In HIV-associated PC, 30-day and 180-day all-cause mortality varied significantly across CD4+ T-lymphocyte count strata, with progressively lower mortality among patients with higher CD4+ T-lymphocyte counts (30-day: Log-rank p = 0.016, trend p = 0.004; 180-day: Log-rank p = 0.008, trend p = 0.002). Refined CD4+ T-lymphocyte count stratification was a predictor of 30-day and 180-day mortality in HIV-associated PC (30-day: HR = 0.10, 95% CI: 0.01-0.96, p = 0.046; 180-day: HR = 0.31, 95% CI: 0.12-0.81, p = 0.017). C-reactive protein (CRP) levels, coexisting cryptococcal meningitis (CM), and combination antifungal therapy showed time-dependent effects, primarily within 30 days. The multivariable model demonstrated superior discrimination for both 30-day and 180-day mortality compared with the model based solely on CD4+ T-lymphocyte count strata. CONCLUSION:Lower refined baseline CD4+ T-lymphocyte count strata are associated with higher 30-day and 180-day mortality in HIV-associated PC and may help guide risk assessment and treatment decision-making. KEY WORDS:Human immunodeficiency virus, Pulmonary cryptococcosis, CD4+ T-lymphocyte count stratification, Mortality.