Cryptococcal-related Mortality Despite Fluconazole Preemptive Treatment in a Cryptococcal Antigen Screen-and-Treat Program

Abstract Background Cryptococcal antigen (CrAg) screening and treatment with preemptive fluconazole reduces the incidence of clinically evident cryptococcal meningitis in individuals living with advanced human immunodeficiency virus (HIV) disease. However, mortality remains higher in CrAg-positive t...

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Bibliographic Details
Published in:Clinical infectious diseases 2020-04, Vol.70 (8), p.1683-1690
Main Authors: Wake, Rachel M, Govender, Nelesh P, Omar, Tanvier, Nel, Carolina, Mazanderani, Ahmad Haeri, Karat, Aaron S, Ismail, Nazir A, Tiemessen, Caroline T, Jarvis, Joseph N, Harrison, Thomas S
Format: Article
Language:English
Subjects:
and Commentaries
Antigens, Fungal
CD4 Lymphocyte Count
Cohort Studies
Cryptococcus
Fluconazole - therapeutic use
HIV Infections - complications
Humans
Meningitis, Cryptococcal - diagnosis
Meningitis, Cryptococcal - drug therapy
South Africa - epidemiology
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Summary:Abstract Background Cryptococcal antigen (CrAg) screening and treatment with preemptive fluconazole reduces the incidence of clinically evident cryptococcal meningitis in individuals living with advanced human immunodeficiency virus (HIV) disease. However, mortality remains higher in CrAg-positive than in CrAg-negative patients with similar CD4+ T-lymphocyte counts. Methods We conducted a cohort study to investigate causes of morbidity and mortality during 6 months of follow-up among asymptomatic CrAg-positive and CrAg-negative (ratio of 1:2) patients living with HIV with CD4 counts
ISSN:1058-4838
1537-6591
DOI:10.1093/cid/ciz485