ArticleJournal of the International AIDS Society2014
Asymptomatic cryptococcal antigenemia is associated with mortality among HIV-positive patients in Indonesia.
Article in Journal of the International AIDS Society, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 2 of them syntheses that pooled it.
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Who cites it
20 citing papers in PubMed, 2 syntheses or guidelines pooled it, 53 citations in OpenAlex.
- Cryptococcal antigenemia and its predictors among HIV infected patients in resource limited settings: a systematic review.BMC infectious diseases · 2020Pooled it
- CD4 Cell Count Threshold for Cryptococcal Antigen Screening of HIV-Infected Individuals: A Systematic Review and Meta-analysis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2018Pooled it
- Article
- Non-acquired immunodeficiency syndrome-related cryptococcal meningitis with recurrent acute stroke: A case report.The Journal of international medical research · 2025Article
- Asymptomatic cryptococcal antigenemia in HIV-infected patients: a review of recent studies.Chinese medical journal · 2020Review
- Multicenter Cryptococcal Antigen Screening of HIV-Infected Patients in Iran.Current microbiology · 2020Article
- Clinical Significance of Low Serum Cryptococcal Antigen Titers by Lateral Flow Assay in Immunocompromised Patients: a Retrospective Case-Control Study.Journal of clinical microbiology · 2020Article
- Underlying Cryptococcal Diseases and the Correlation With Serum Cryptococcal Antigen Titers in Hospitalized HIV-Infected Patients Screened Positive for Cryptococcal Antigenemia.Frontiers in cellular and infection microbiology · 2020Article
- Cryptococcal antigenemia and associated risk factors among ART-naïve and ART-experienced HIV-infected peoples at selected health institutions of Mekelle, Northern Ethiopia.MicrobiologyOpen · 2019Article
- Article
- Article
- Opportunistic diseases diminish the clinical benefit of immediate antiretroviral therapy in HIV-tuberculosis co-infected adults with low CD4+ cell counts.AIDS (London, England) · 2018Article
- Neurocognitive function in HIV-infected persons with asymptomatic cryptococcal antigenemia: a comparison of three prospective cohorts.BMC neurology · 2017Article
- Cryptococcal meningitis: A neglected NTD?PLoS neglected tropical diseases · 2017Article
- Cost-effectiveness of CRAG-LFA screening for cryptococcal meningitis among people living with HIV in Uganda.BMC infectious diseases · 2017Article
- Integrated therapy for HIV and cryptococcosis.AIDS research and therapy · 2016Review
- Cryptococcal Antigen Screening in Patients Initiating ART in South Africa: A Prospective Cohort Study.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2016Article
- Implementation and operational research: Integrated pre-antiretroviral therapy screening and treatment for tuberculosis and cryptococcal antigenemia.Journal of acquired immune deficiency syndromes (1999) · 2015Article
- Utility of urine and serum lateral flow assays to determine the prevalence and predictors of cryptococcal antigenemia in HIV-positive outpatients beginning antiretroviral therapy in Mwanza, Tanzania.Journal of the International AIDS Society · 2014Article
- Preventing Cryptococcosis-Shifting the Paradigm in the Era of Highly Active Antiretroviral Therapy.Current tropical medicine reportsReview
Corrections and comments
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Authors and funding
7 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionPrevious studies, mostly from Africa, have shown that serum cryptococcal antigenemia may precede the development of cryptococcal meningitis and early death among patients with advanced HIV infection. We examined cryptococcal antigenemia as a risk factor for HIV-associated mortality in Indonesia, which is experiencing a rapidly growing HIV epidemic.
methodsWe included ART-naïve HIV patients with a CD4 cell count below 100 cells/μL and no signs of meningitis in an outpatient HIV clinic in Bandung, West Java, Indonesia. Baseline clinical data and follow-up were retrieved from a prospective database, and cryptococcal antigen was measured in stored serum samples using a semiquantitative lateral flow assay. Cox regression analysis was used to identify factors related to mortality.
resultsAmong 810 patients (median CD4 cell count 22), 58 (7.1%) had a positive cryptococcal antigen test with a median titre of 1:80 (range: 1:1 to 1:2560). Cryptococcal antigenemia at baseline was strongly associated with the development of cryptococcal meningitis and early death and loss to follow-up. After one year, both death (22.4% vs. 11.6%; p=0.016; adjusted HR 2.19; 95% CI 1.78-4.06) and the combined endpoint of death or loss to follow-up (67.2% vs. 40.4%; p<0.001; adjusted HR 1.57; 95% CI 1.12-2.20) were significantly higher among patients with a positive cryptococcal antigen test.
conclusionsCryptococcal antigenemia is common and clinically relevant among patients with advanced HIV in this setting. Routine screening for cryptococcal antigen followed by lumbar puncture and pre-emptive antifungal treatment for those who are positive may help in reducing early mortality.
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