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Review
. 2012 Apr 15;59(5):e85-91.
doi: 10.1097/QAI.0b013e31824c837e.

Integrating cryptococcal antigen screening and pre-emptive treatment into routine HIV care

Radha Rajasingham  1 , David B Meya, David R Boulware
Affiliations
Review

Integrating cryptococcal antigen screening and pre-emptive treatment into routine HIV care

Radha Rajasingham et al. J Acquir Immune Defic Syndr. .

Abstract

Cryptococcal meningitis is a leading cause of death in AIDS patients in sub-Saharan Africa. Cryptococcal antigen (CRAG) can be detected weeks before onset of symptoms, and those who are asymptomatic but CRAG positive have a high risk of subsequent cryptococcal meningitis and mortality. A new CRAG point of care immunochromatographic test is available that is remarkably easy to administer without laboratory infrastructure or expertise and has excellent sensitivity and specificity. We review the benefits of targeted CRAG screening, developments in CRAG diagnostics, and evidence regarding treatment options that can be implemented into routine HIV care in areas of high cryptococcal burden. Based on published CRAG+ prevalence rates of 2%-12%, the cost to save one life is between $20 to $140 in sub-Saharan Africa. We provide recommendations for implementation, pre-emptive treatment, and identify the gaps in our current knowledge.

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Conflict of interest statement

Conflicts of Interest

No author has a financial conflict of interest

Figures

Figure 1
Figure 1
Prevalence of asymptomatic antigenemia with corresponding cost per life saved based on LFA cost of $2.50 per test.
Figure 2
Figure 2
Example of Lateral Flow Assay (LFA)
Figure 3
Figure 3
Algorithm for CRAG screening upon entry into HIV care
See this image and copyright information in PMC

References

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