OBJECTIVE To systematically evaluate the efficacy and safety of different induction regimens for AIDS complicated with cryptococcal meningitis.

METHODS PubMed, Embase, Cochranre library, Web of science, CNKI, Wanfang, Weipu and other databases were systematically searched to collect randomized controlled trials related to the induction treatments of AIDS complicated with cryptococcal meningitis. The search was limited to Oct. 2024. The Cochrane risk of bias evaluation system was used to evaluate the quality of the literature, and Stata 15.1 and Revman 5.3 software were used for network meta-analysis.

RESULTS A total of 17 randomized controlled trials involving 3, 281 patients were included. The result of network meta-analysis showed that the treatment regimen with the lowest early mortality was the short-course of amphotericin B + fluconazole + flucytosine; the regimen with the lowest late mortality was a single high-dose amphotericin B liposome; the regimen with the highest 14-day fungal clearance rate was amphotericin B + flucytosine; the regimen with the lowest incidence of grade 3+4 anemia was a single high-dose amphotericin B liposome; the regimen with the lowest incidence of grade 3+4 renal injury was amphotericin B liposome; the regimen with the lowest incidence of grade 3-4 hypokalemia was fluconazole + flucytosine.

CONCLUSION According to the comprehensive analysis of various indices, there is good efficacy and safety for the inclusion of short-course amphotericin B regimen and single high-dose amphotericin B liposome as induction period therapy for AIDS complicated with cryptococcal meningitis.