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

David Meya; Radha Rajasingham; Elizabeth Nalintya; Mark Tenforde; Joseph N Jarvis

doi:10.1007/s40475-015-0045-z

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

Curr Trop Med Rep. 2015;2(2):81-89. doi: 10.1007/s40475-015-0045-z.

Authors

David Meya¹, Radha Rajasingham², Elizabeth Nalintya³, Mark Tenforde⁴, Joseph N Jarvis⁵

Affiliations

¹ Infectious Disease Institute, College of Health Sciences, Makerere University, Mulago Hill Road, # 22418, Kampala, Uganda ; Department of Medicine, Center for Infectious Diseases and Microbiology Translational Research, University of Minnesota, 450 Delaware Street, MMC250, Minneapolis, MN 55455 USA ; School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
² Department of Medicine, Center for Infectious Diseases and Microbiology Translational Research, University of Minnesota, 450 Delaware Street, MMC250, Minneapolis, MN 55455 USA.
³ Infectious Disease Institute, College of Health Sciences, Makerere University, Mulago Hill Road, # 22418, Kampala, Uganda.
⁴ Botswana-UPenn Partnership, P.O. Box AC 157 ACH, Gaborone, Botswana.
⁵ Botswana-UPenn Partnership, P.O. Box AC 157 ACH, Gaborone, Botswana ; Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA ; London School of Hygiene and Tropical Medicine, London, UK.

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.

Keywords: CD4; CRAG screening; Cryptococcal antigen; Cryptococcosis; Fluconazole; HIV; Preemptive therapy.

Publication types

Review

Abstract

Publication types

Grants and funding