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Impact of Routine Cryptococcal Antigen Screening and Targeted Preemptive Fluconazole Therapy in Antiretroviral-naive Human Immunodeficiency Virus–infected Adults With CD4 Cell Counts <100/μL: A Systematic Review and Meta-analysis

Abstract : Cryptococcal antigen (CrAg) screening and targeted preemptive fluconazole in antiretroviral-naive human immunodeficiency virus-infected adults with CD4 cell counts <100/μL seems promising as a strategy to reduce the burden of cryptococcal meningitis (CM). We searched MEDLINE, EMBASE, and Web of Science and used random-effect meta-analysis to assess the prevalence of blood CrAg positivity (31 studies; 35644 participants) and asymptomatic CM in CrAg-positive participants and the incidence of CM and the all-cause mortality rate in screened participants. The pooled prevalence of blood CrAg-positivity was 6% (95% confidence interval [CI], 5%-7%), and the prevalence of asymptomatic CM in CrAg-positive participants was 33% (95% CI, 21%-45%). The incidence of CM was 21.4% (95% CI, 11.6%-34.4%) without preemptive fluconazole and 5.7% (95% CI, 3.0%-9.7%) with preemptive fluconazole therapy initiated at 800 mg/d. In CrAg-positive participants, postscreening lumbar puncture before initiating preemptive fluconazole at 800 mg/d further reduced the incidence of CM to null and showed some survival benefits. However, the all-cause mortality rate remained significantly higher in CrAg-positive than in CrAg-negative participants (risk ratio, 2.2; 95% CI, 1.7-2.9; P < .001).
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https://hal-pasteur.archives-ouvertes.fr/pasteur-02193022
Contributor : Reine Bouyssie <>
Submitted on : Wednesday, July 24, 2019 - 11:14:13 AM
Last modification on : Friday, March 27, 2020 - 2:38:05 AM

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Elvis Temfack, Jean Joel Bigna, Henry Luma, Rene Spijker, Graeme Meintjes, et al.. Impact of Routine Cryptococcal Antigen Screening and Targeted Preemptive Fluconazole Therapy in Antiretroviral-naive Human Immunodeficiency Virus–infected Adults With CD4 Cell Counts <100/μL: A Systematic Review and Meta-analysis. Clinical Infectious Diseases, Oxford University Press (OUP), 2019, 68 (4), pp.688-698. ⟨10.1093/cid/ciy567⟩. ⟨pasteur-02193022⟩

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