Background: Current WHO guidelines (2018) recommend screening for cryptococcal antigen (CrAg) in HIV-infected persons with CD4<100 cells/μL, followed by pre-emptive antifungal therapy among CrAg positive (CrAg+) persons, to prevent Cryptococcal meningitis related deaths. The strategy may also be considered for those persons with a CD4 count of<200 cells/uL according the WHO guidelines. However, there remains little evidence for doing so in those HIV-infected persons with this CD4 cell count.
Objective: We aimed to assess the necessity of CrAg screening and the efficacy of pre-emptive antifungal therapy in CrAg+ persons with CD4<200 cells/µL.
Methods: We conducted a meta-analysis using data obtained from randomized controlled studies (RCTs) and cohort studies found in Pubmed, Web of Science, Cochrane Library and EMBASE/MEDLINE.
Results: The pooled prevalence of CrAg positivity in HIV-infected persons with CD4<200 cells/µL was 5% (95%CI: 3-6). The incidence of CM in CrAg+ persons was 7- fold (7%, 95%CI: 4-10) that of CrAg negative (CrAg-) persons (1%, 95%CI: 0-1). Among CrAg+ persons who did not receive any treatment or only received placebo, the incidence of CM was 9% (95%CI: 5-13), whereas the incidence of CM among those who received antifungal therapy was 2% (95%CI: 0-3), a highly statistically significant reduction of 78% (RR: 6.03, 95%CI: 2.74-13.24, p<0.00001).
Conclusions: In our meta-analysis, the incidence of CM in CrAg+ persons were significantly higher than in CrAg- persons with CD4<200 cells/µL. Furthermore, the incidence of CM was significantly reduced by pre-emptive antifungal therapy in CrAg+ persons with CD4<200 cells/µL.
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Background: Current WHO guidelines (2018) recommend screening for cryptococcal antigen (CrAg) in HIV-infected persons with CD4<100 cells/μL, followed by pre-emptive antifungal therapy among CrAg positive (CrAg+) persons, to prevent Cryptococcal meningitis related deaths. The strategy may also be considered for those persons with a CD4 count of<200 cells/uL according the WHO guidelines. However, there remains little evidence for doing so in those HIV-infected persons with this CD4 cell count.
Objective: We aimed to assess the necessity of CrAg screening and the efficacy of pre-emptive antifungal therapy in CrAg+ persons with CD4<200 cells/µL.
Methods: We conducted a meta-analysis using data obtained from randomized controlled studies (RCTs) and cohort studies found in Pubmed, Web of Science, Cochrane Library and EMBASE/MEDLINE.
Results: The pooled prevalence of CrAg positivity in HIV-infected persons with CD4<200 cells/µL was 5% (95%CI: 3-6). The incidence of CM in CrAg+ persons was 7- fold (7%, 95%CI: 4-10) that of CrAg negative (CrAg-) persons (1%, 95%CI: 0-1). Among CrAg+ persons who did not receive any treatment or only received placebo, the incidence of CM was 9% (95%CI: 5-13), whereas the incidence of CM among those who received antifungal therapy was 2% (95%CI: 0-3), a highly statistically significant reduction of 78% (RR: 6.03, 95%CI: 2.74-13.24, p<0.00001).
Conclusions: In our meta-analysis, the incidence of CM in CrAg+ persons were significantly higher than in CrAg- persons with CD4<200 cells/µL. Furthermore, the incidence of CM was significantly reduced by pre-emptive antifungal therapy in CrAg+ persons with CD4<200 cells/µL.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
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