ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2016
Cryptococcal Antigen Screening in Patients Initiating ART in South Africa: A Prospective Cohort Study.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 71 papers, 3 of them syntheses that pooled it.
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Who cites it
71 citing papers in PubMed, 3 syntheses or guidelines pooled it, 119 citations in OpenAlex.
- Cryptococcal Antigen in Serum and Cerebrospinal Fluid for Detecting Cryptococcal Meningitis in Adults Living With Human Immunodeficiency Virus: Systematic Review and Meta-Analysis of Diagnostic Test Accuracy Studies.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Pooled it
- 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
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- Reflexive Laboratory-Based Cryptococcal Antigen Screening and Preemptive Fluconazole Therapy for Cryptococcal Antigenemia in HIV-Infected Individuals With CD4 <100 Cells/µL: A Stepped-Wedge, Cluster-Randomized Trial.Journal of acquired immune deficiency syndromes (1999) · 2019Trial
- Cryptococcal antigen titers and semi-quantitative assay scores among people with HIV-associated cryptococcal antigenemia.Journal of clinical microbiology · 2026Article
- Accuracy and Acceptability of the VISITECT CD4 Advanced Disease Test Compared With the PIMA CD4 Test at the Point of Care as Part of the Advanced HIV Disease Care Package: A Mixed-Methods Study.Open forum infectious diseases · 2026Article
- Impact of an optimized care model for advanced HIV disease: a non-randomized cluster study in Malawi.BMC public health · 2025Article
- Uptake of lumbar puncture and mortality among patients with advanced human immunodeficiency virus disease who screened for serum cryptococcal-antigen in Africa.World journal of virology · 2025Article
- Clinical treatment of cryptococcal meningitis: an evidence-based review on the emerging clinical data.Journal of neurology · 2024Review
- Cryptococcal meningitis.Nature reviews. Disease primers · 2023Review
- Disseminated Cryptococcosis Is a Common Finding among Human Immunodeficiency Virus-Infected Patients with Suspected Sepsis and Is Associated with Higher Mortality Rates.Journal of fungi (Basel, Switzerland) · 2023Article
- An Overview of Diagnostic and Management Strategies for Talaromycosis, an Underrated Disease.Journal of fungi (Basel, Switzerland) · 2023Review
- Preemptive Therapy in Cryptococcosis Adjusted for Outcomes.Journal of fungi (Basel, Switzerland) · 2023Article
- Diagnostic accuracy of cryptococcal antigen test in pulmonary cryptococcosis: a protocol for a systematic review and meta-analysis.BMJ open · 2023Article
- Hyponatremia as a Predictor of Cryptococcal Meningitis and Death Among Asymptomatic Persons With HIV and Cryptococcal Antigenemia.Open forum infectious diseases · 2023Article
- Association of Antibody Immunity With Cryptococcal Antigenemia and Mortality in a South African Cohort With Advanced Human Immunodeficiency Virus Disease.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Article
- Mapping evidence on cryptococcal antigen infection among HIV-infected persons in sub-Saharan Africa- A scoping review protocol.PloS one · 2023Article
- The global burden of HIV-associated cryptococcal infection in adults in 2020: a modelling analysis.The Lancet. Infectious diseases · 2022Article
11 more citing papers are in PubMed but not listed here.
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Authors and funding
10 authors at 6 institutions in 4 countries.
Funding
Abstract
backgroundRetrospective data suggest that cryptococcal antigen (CrAg) screening in patients with late-stage human immunodeficiency virus (HIV) initiating antiretroviral therapy (ART) may reduce cryptococcal disease and deaths. Prospective data are limited.
methodsCrAg was measured using lateral flow assays (LFA) and latex agglutination (LA) tests in 645 HIV-positive, ART-naive patients with CD4 counts ≤100 cells/µL in Cape Town, South Africa. CrAg-positive patients were offered lumbar puncture (LP) and treated with antifungals. Patients were started on ART between 2 and 4 weeks and followed up for 1 year.
resultsA total of 4.3% (28/645) of patients were CrAg positive in serum and plasma with LFA. These included 16 also positive by urine LFA (2.5% of total screened) and 7 by serum LA (1.1% of total). In 4 of 10 LFA-positive cases agreeing to LP, the cerebrospinal fluid (CSF) CrAg LFA was positive. A positive CSF CrAg was associated with higher screening plasma/serum LFA titers.Among the 28 CrAg-positive patients, mortality was 14.3% at 10 weeks and 25% at 12 months. Only 1 CrAg-positive patient, who defaulted from care, died from cryptococcal meningitis (CM). Mortality in CrAg-negative patients was 11.5% at 1 year. Only 2 possible CM cases were identified in CrAg-negative patients.
conclusionsCrAg screening of individuals initiating ART and preemptive fluconazole treatment of CrAg-positive patients resulted in markedly fewer cases of CM compared with historic unscreened cohorts. Studies are needed to refine management of CrAg-positive patients who have high mortality that does not appear to be wholly attributable to cryptococcal disease.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.