Impact of Routine Cryptococcal Antigen Screening and Targeted Preemptive Fluconazole Therapy in Antiretroviral-naive Human Immunodeficiency Virus-infected Adults With CD4 Cell Counts <100/μL: A Systematic Review and Meta-analysis

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
Elvis TemfackOlivier Lortholary

Abstract

Cryptococcal antigen (CrAg) screening and targeted preemptive fluconazole in antiretroviral-naive human immunodeficiency virus-infected adults with CD4 cell counts <100/μL seems promising as a strategy to reduce the burden of cryptococcal meningitis (CM). We searched MEDLINE, EMBASE, and Web of Science and used random-effect meta-analysis to assess the prevalence of blood CrAg positivity (31 studies; 35644 participants) and asymptomatic CM in CrAg-positive participants and the incidence of CM and the all-cause mortality rate in screened participants. The pooled prevalence of blood CrAg-positivity was 6% (95% confidence interval [CI], 5%-7%), and the prevalence of asymptomatic CM in CrAg-positive participants was 33% (95% CI, 21%-45%). The incidence of CM was 21.4% (95% CI, 11.6%-34.4%) without preemptive fluconazole and 5.7% (95% CI, 3.0%-9.7%) with preemptive fluconazole therapy initiated at 800 mg/d. In CrAg-positive participants, postscreening lumbar puncture before initiating preemptive fluconazole at 800 mg/d further reduced the incidence of CM to null and showed some survival benefits. However, the all-cause mortality rate remained significantly higher in CrAg-positive than in CrAg-negative participants (risk ratio, 2.2; ...Continue Reading

References

Apr 16, 2002·AIDS·Neil FrenchCharles F Gilks
Mar 11, 2003·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Sara A MirzaRana A Hajjeh
Apr 20, 2004·AIDS·Françoise DromerUNKNOWN French Cryptococcosis Study Group
Aug 19, 2007·Tropical Medicine & International Health : TM & IH·Cheryl A LiechtyJonathan Mermin
Apr 30, 2008·Mycopathologia·Ana Lusia LealMarilene H Vainstein
Feb 19, 2009·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Joseph N JarvisThomas S Harrison
Feb 2, 2010·Transplant Infectious Disease : an Official Journal of the Transplantation Society·D NeofytosK A Marr
Mar 12, 2010·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Peter G PappasTom M Chiller
Mar 17, 2010·BMC Infectious Diseases·Joseph N JarvisThomas S Harrison
Jul 6, 2010·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·David B MeyaDavid R Boulware
Oct 11, 2011·The Lancet Infectious Diseases·Olivier Lortholary, Thomas S Harrison
Jan 31, 2014·Journal of the International AIDS Society·Ahmad Rizal GaniemReinout van Crevel
Jan 1, 2014·Archives of public health = Archives belges de santé publique·Victoria N NyagaMarc Aerts
Mar 31, 2015·Studies in History and Philosophy of Science·Sally Cochrane
May 12, 2015·Current Tropical Medicine Reports·David MeyaJoseph N Jarvis
Jul 4, 2015·Journal of the International Association of Providers of AIDS Care·Chifundo ChipunguJeffrey D Klausner
Jul 15, 2015·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Yukari C Manabe, Richard D Moore
Nov 14, 2015·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Arthur Timothy Jackson, Charles Michael van der Horst
Nov 14, 2015·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Nicky LongleyThomas S Harrison
Sep 20, 2016·Journal de mycologie médicale·A Ogouyèmi-HountoD Kinde Gazard
Mar 18, 2017·Indian Journal of Medical Microbiology·Dileep KadamVidya Mave
May 10, 2017·The Lancet Infectious Diseases·Radha RajasinghamDavid R Boulware
Oct 14, 2017·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Rachel M WakeNelesh P Govender
Jan 27, 2018·Open Forum Infectious Diseases·Mahsa AbassiDavid R Boulware
Mar 7, 2018·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Elizabeth NalintyaRadha Rajasingham
Mar 8, 2018·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Nathan FordGraeme Meintjes
Mar 15, 2018·The New England Journal of Medicine·Síle F MolloyUNKNOWN ACTA Trial Study Team

❮ Previous
Next ❯

Citations

Apr 3, 2020·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·William J HurtJoseph N Jarvis
Nov 2, 2019·Current Neurology and Neuroscience Reports·Elvis TemfackOlivier Lortholary
Jun 23, 2020·Expert Review of Anti-infective Therapy·Greg GreeneJoseph N Jarvis
Apr 17, 2020·Current Microbiology·Zainab BandalizadehSeyedmojtaba Seyedmousavi
Aug 7, 2020·The Journal of Infectious Diseases·Melissa D JohnsonDimitrios P Kontoyiannis
Jul 1, 2020·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Mark W TenfordeJoseph N Jarvis
Oct 22, 2020·Chinese Medical Journal·Xiao-Lei XuYao-Kai Chen
Aug 24, 2020·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Elvis TemfackOlivier Lortholary
Dec 5, 2020·Chinese Medical Journal·Xiao-Lei XuYao-Kai Chen
Jun 1, 2021·Infectious Diseases and Therapy·Sung-Hsi HuangUNKNOWN Taiwan HIV Study Group

❮ Previous
Next ❯

Related Concepts

Trending Feeds

COVID-19

Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

Blastomycosis

Blastomycosis fungal infections spread through inhaling Blastomyces dermatitidis spores. Discover the latest research on blastomycosis fungal infections here.

Nuclear Pore Complex in ALS/FTD

Alterations in nucleocytoplasmic transport, controlled by the nuclear pore complex, may be involved in the pathomechanism underlying multiple neurodegenerative diseases including Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. Here is the latest research on the nuclear pore complex in ALS and FTD.

Applications of Molecular Barcoding

The concept of molecular barcoding is that each original DNA or RNA molecule is attached to a unique sequence barcode. Sequence reads having different barcodes represent different original molecules, while sequence reads having the same barcode are results of PCR duplication from one original molecule. Discover the latest research on molecular barcoding here.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Evolution of Pluripotency

Pluripotency refers to the ability of a cell to develop into three primary germ cell layers of the embryo. This feed focuses on the mechanisms that underlie the evolution of pluripotency. Here is the latest research.

Position Effect Variegation

Position Effect Variagation occurs when a gene is inactivated due to its positioning near heterochromatic regions within a chromosome. Discover the latest research on Position Effect Variagation here.

STING Receptor Agonists

Stimulator of IFN genes (STING) are a group of transmembrane proteins that are involved in the induction of type I interferon that is important in the innate immune response. The stimulation of STING has been an active area of research in the treatment of cancer and infectious diseases. Here is the latest research on STING receptor agonists.

Microbicide

Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections. Here is the latest research on microbicides.