Preventing Cryptococcosis—Shifting the Paradigm in the Era of Highly Active Antiretroviral Therapy

David Meya, Radha Rajasingham, Elizabeth Nalintya, Mark Tenforde, Joseph N. Jarvis

Research output: Contribution to journalReview articlepeer-review

28 Scopus citations

Abstract

Cryptococcosis remains a significant cause of morbidity and mortality among HIV-infected patients, especially in sub-Saharan Africa where it causes up to 20 % of AIDS-related deaths in HIV programs. A new, highly sensitive, and affordable point of care diagnostic test for cryptococcal infection, the lateral flow assay, can detect early sub-clinical cryptococcosis especially in areas with limited laboratory infrastructure. With a prevalence of detectable sub-clinical cryptococcal infection averaging 7.2 % (95 % CI 6.8–7.6 %) among 36 cohorts with CD4 <100 cells/μL in Africa, together with data showing that preemptive fluconazole prevents overt cryptococcal disease in this population, implementing a screen and treat strategy as part of HIV care practice among patients with CD4 <100 cells/μL could prevent the incidence of often fatal cryptococcal meningitis in the setting of the HIV pandemic.

Original languageEnglish (US)
Pages (from-to)81-89
Number of pages9
JournalCurrent Tropical Medicine Reports
Volume2
Issue number2
DOIs
StatePublished - Jun 1 2015

Bibliographical note

Funding Information:
This work was supported by research grants from the Welcome Trust (Training Health Researchers into Vocational Excellence (THRiVE)) in East Africa, grant number 087540 (DBM), National Institutes of Health (R01AI078934, U01AI089244, R01AI108479 (DB)), CDC/PEPFAR grant number UO1GH000517 (DBM, RR, EN), and Afya Bora Fellowship in Global Health Leadership, grant number U91HA06801B (MT).

Publisher Copyright:
© 2015, The Author(s).

Keywords

  • CD4
  • CRAG screening
  • Cryptococcal antigen
  • Cryptococcosis
  • Fluconazole
  • HIV
  • Preemptive therapy

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