Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS

@article{Park2009EstimationOT,
  title={Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS},
  author={Benjamin J Park and Kathleen Wannemuehler and Barbara J. Marston and Nelesh P. Govender and Peter G. Pappas and Tom Chiller},
  journal={AIDS},
  year={2009},
  volume={23},
  pages={525–530}
}
OBJECTIVE Cryptococcal meningitis is one of the most important HIV-related opportunistic infections, especially in the developing world. [] Key MethodMETHODS We used the median incidence rate of available studies in a geographic region to estimate the region-specific cryptococcal meningitis incidence; this was multiplied by the 2007 United Nations Programme on HIV/AIDS HIV population estimate for each region to estimate cryptococcal meningitis cases.
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1,845 Citations

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Despite recent expansion of antiretroviral treatment (ART) programmes in developing countries, Cryptococcal meningitis remains a major opportunistic infection, and a leading cause of mortality in acquired immune deficiency syndrome (AIDS) patients.
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The prevalence of cryptococcal infection among advanced AIDS patients in the United States was high and above the published cost-effectiveness threshold for routine screening, and routine CrAg screening among human immunodeficiency virus-infected patients with a CD4 count ≤100 cells/µL is recommended to detect and treat early infection.
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The results show that the “treatment gap” is not narrowed, and AIDS-related illness such as cryptococcal meningitis and the associated mortality are not reduced, despite a major effort to expand access to ART throughout sub-Saharan Africa over recent years.
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To quantify the prevalence of undiagnosed cryptococcal infection in HIV-infected persons in the United States during 1986-2012, stored sera from 1,872 participants in the Multicenter AIDS Cohort Study and the Women's Interagency HIV Study with CD4 T-cell counts <100 cells/µL were screened for CrAg, which indicated the overall prevalence of CrAg positivity to be 2.9%.
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This chapter focuses primarily on HIV-associated cryptococcosis, due to its much greater public health burden, and discusses the challenges to public health agencies in addressing the threat of…
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Early diagnosis, proactive antifungal therapy with concurrent management of raised intracranial pressure creates the potential to markedly reduce mortality associated with this disease.
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TLDR
Even in a setting where amphotericin B is available, mortality from cryptococcal meningitis in this setting is high, particularly in the immediate period after diagnosis, which highlights the still unmet need not only for earlier diagnosis of HIV and timely access to treatment of opportunistic infections, but for better treatment strategies.
High Prevalence of Cryptococcal Antigenemia among HIV-infected Patients Receiving Antiretroviral Therapy in Ethiopia
TLDR
Cryptococcal antigenemia is high in Ethiopia and rapid scale up of screening programs is needed, and Screening should be implemented for HIV-infected patients with low CD4 counts regardless of symptoms or receipt of ART.
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