Routine cryptococcal antigen screening for HIV-infected patients with low CD4+ T-lymphocyte counts - time to implement in South Africa?

Jarvis, Joseph N; Harrison, Thomas S; Govender, Nelesh; Lawn, Stephen D; Longley, Nicky; Bicanic, Tihana; Maartens,  Gary; Venter, Francois; Bekker, Linda-Gail; Wood,  Robin; Meintjes, Graeme

Routine cryptococcal antigen screening for HIV-infected patients with low CD4+ T-lymphocyte counts - time to implement in South Africa?

Journal Article

2011

Journal Title

South African Medical Journal

Link to Journal

http://www.samj.org.za/index.php/samj

Publisher

University of Cape Town

Department

Institute of Infectious Disease and Molecular Medicine

Faculty

Faculty of Health Sciences

Abstract

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 cases2), 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an urban hospital in Johannesburg, 67% of patients had died or were lost to follow-up at 3 months (N Govender et al., unpublished data).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.

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