Cryptococcal antigen screening and preemptive therapy in patients initiating antiretroviral therapy in resource-limited settings: a proposed algorithm for clinical implementation.


Jarvis, JN; Govender, N; Chiller, T; Park, BJ; Longley, N; Meintjes, G; Bekker, LG; Wood, R; Lawn, SD; Harrison, TS; (2012) Cryptococcal antigen screening and preemptive therapy in patients initiating antiretroviral therapy in resource-limited settings: a proposed algorithm for clinical implementation. Journal of the International Association of Physicians in AIDS Care (Chicago, Ill, 11 (6). pp. 374-9. ISSN 1545-1097 DOI: https://doi.org/10.1177/1545109712459077

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Abstract

HIV-associated cryptococcal meningitis (CM) is estimated to cause over half a million deaths annually in Africa. Many of these deaths are preventable. Screening patients for subclinical cryptococcal infection at the time of entry into antiretroviral therapy programs using cryptococcal antigen (CRAG) immunoassays is highly effective in identifying patients at risk of developing CM, allowing these patients to then be targeted with "preemptive" therapy to prevent the development of severe disease. Such CRAG screening programs are currently being implemented in a number of countries; however, a strong evidence base and clear guidance on how to manage patients with subclinical cryptococcal infection identified by screening are lacking. We review the available evidence and propose a treatment algorithm for the management of patients with asymptomatic cryptococcal antigenemia.

Item Type: Article
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
PubMed ID: 23015379
URI: http://researchonline.lshtm.ac.uk/id/eprint/612449

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