Back to Search
Start Over
The prevalence of cryptococcal antigen (CrAg) and benefits of pre-emptive antifungal treatment among HIV-infected persons with CD4+ T-cell counts < 200 cells/μL: evidence based on a meta-analysis.
- Source :
-
BMC infectious diseases [BMC Infect Dis] 2020 Jun 12; Vol. 20 (1), pp. 410. Date of Electronic Publication: 2020 Jun 12. - Publication Year :
- 2020
-
Abstract
- Background: Current WHO guidelines (2018) recommend screening for cryptococcal antigen (CrAg) in HIV-infected persons with CD4+ T cell counts< 100 cells/μL, followed by pre-emptive antifungal therapy among CrAg positive (CrAg+) persons, to prevent cryptococcal meningitis related deaths. This strategy may also be considered for those persons with a CD4+ T cell count of < 200 cells/uL according the WHO guidelines. However, there is sparse evidence in the literature supporting CrAg screening and pre-emptive antifungal therapy in those HIV-infected persons with this CD4+ T cell counts< 200 cells/μL.<br />Method: We conducted a meta-analysis using data extracted from randomized controlled studies (RCTs) and cohort studies found in a search of Pubmed, Web of Science, the Cochrane Library and the EMBASE/MEDLINE database.<br />Results: The pooled prevalence of CrAg positivity in HIV-infected persons with CD4+ T cell counts< 200 cells/μL was 5% (95%CI: 2-7). The incidence of CM in CrAg+ persons was 3% (95%CI: 1-6). Among those CrAg+ persons who did not receive pre-emptive treatment, or those who received placebo, the incidence of CM was 5% (95%CI: 2-9), whereas the incidence of CM among those who received pre-emptive antifungal therapy was 3% (95%CI: 1-6), which is a statistically significant reduction in incidence of 40% (RR: 7.64, 95%CI: 2.96-19.73, p < 0.00001). As for persons with CD4+ T cell counts between 101 ~ 200 cells/μL, the risk ratio for the incidence of CM among those receiving placebo or no intervention was 1.15, compared to those receiving antifungal treatment (95%CI: 0.16-8.13).<br />Conclusions: In our meta-analysis the incidence of CM was significantly reduced by pre-emptive antifungal therapy in CrAg+ HIV-infected persons with CD4 <  200 cells/μL. However, more specific observational data in persons with CD4+ T cell counts between 101 ~ 200 cells/μL are required in order to emphasize specific benefit of CrAg screening and pre-emptive antifungal treating in CrAg+ persons with CD4+ T cell counts < 200 cells/μL.
- Subjects :
- AIDS-Related Opportunistic Infections immunology
AIDS-Related Opportunistic Infections microbiology
Antigens, Fungal blood
CD4 Lymphocyte Count
Cryptococcus immunology
Cryptococcus isolation & purification
Humans
Incidence
Mass Screening
Meningitis, Cryptococcal immunology
Meningitis, Cryptococcal microbiology
Prevalence
AIDS-Related Opportunistic Infections diagnosis
AIDS-Related Opportunistic Infections prevention & control
Antifungal Agents therapeutic use
Meningitis, Cryptococcal diagnosis
Meningitis, Cryptococcal prevention & control
Subjects
Details
- Language :
- English
- ISSN :
- 1471-2334
- Volume :
- 20
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- BMC infectious diseases
- Publication Type :
- Academic Journal
- Accession number :
- 32532212
- Full Text :
- https://doi.org/10.1186/s12879-020-05126-z