Routine Cryptococcal Antigen Screening for Hiv-Infected Patients with Low CD4+ T-Lymphocyte Counts–Time to Implement in South Africa?(Clinical PRACTICE: Policy) (Cluster of Differentiation) (Report)

Routine Cryptococcal Antigen Screening for Hiv-Infected Patients with Low CD4+ T-Lymphocyte Counts--Time to Implement in South Africa?(Clinical PRACTICE: Policy) (Cluster of Differentiation) (Report)

Cryptococcal meningitis (CM) is a major cause of death among HIV-infected individuals. It causes an estimated 957 900 cases and 624 700 deaths worldwide annually, the vast majority of them in sub-Saharan Africa. (1) In Cape Town, CM is now the most common cause of adult meningitis (63% of all microbiologically confirmed cases (2)), and acute outcomes are poor. (3) Even with optimal treatment in study settings, 10-week mortality rates are between 24% and 37%. (4,5) In 2009, in a routine care setting at an urban hospital in Johannesburg, 67% of patients had died or were lost to follow-up at 3 months (N Govender et al., unpublished data). Unfortunately almost half of South African patients still receive sub-optimal initial treatment with oral fluconazole rather than intravenous amphotericin B. (3,6) Clearly, given the substantial mortality and morbidity associated with CM, preventive interventions should be prioritised. As CM primarily affects patients with CD4+ T-cell counts [less than or equal to] 100 cells/[micro]l, the incidence should fall during scale-up of antiretroviral therapy (ART) programmes, as in the high-income countries. (7) However, despite recent progress in expanding access to ART in South Africa, (8) the median CD4+ T-cell count of patients initiating ART remains low, and a high risk of new AIDS events and mortality persists during the first months of ART. (9) Numbers of CM cases in Cape Town remained constant between 2003 and 2008 despite a large increase in ART coverage, (10) and national surveillance shows slight increases in the incidence of reported CM cases year on year. (11)

Routine Cryptococcal Antigen Screening for Hiv-Infected Patients with Low CD4+ T-Lymphocyte Counts--Time to Implement in South Africa?(Clinical PRACTICE: Policy) (Cluster of Differentiation) (Report)



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