Evidence map›Paper›PMID 28483415›Full record

ArticleThe Lancet. Infectious diseases2017

Global burden of disease of HIV-associated cryptococcal meningitis: an updated analysis.

Radha Rajasingham, Rachel M Smith, Benjamin J Park, Joseph N Jarvis, Nelesh P Govender, Tom M Chiller, David W Denning, Angela Loyse, David R Boulware

Registry-linked trialOpen access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The Lancet. Infectious diseases, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06178627 (A Multi-center, Prospective, Randomized Trial of Amphotericin B in the Initial Antifungal Therapy for Non-HIV Cryptococcal Meningitis Patients), which is not on this map. Cited by 1,171 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1,171citing papers in PubMed, 4 pooled it
142.2field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06178627 phase4enrolling by invitationnot on this mapstarted 2023, after this paper: background citation

A Multi-center, Prospective, Randomized Trial of Amphotericin B in the Initial Antifungal Therapy for Non-HIV Cryptococcal Meningitis Patients

TypeinterventionalSponsorHuashan HospitalRan2023 to 2026Enrolled250ConditionsCryptococcal Meningitis, Antifungal AgentsArmsAmphotericin B 0.5 mg/kg/day i.v. combined with flucytosine four times per day orally for the first 4 weeks., Amphotericin B 0.7 mg/kg/day i.v. combined with flucytosine four times per day orally for the first 4 weeks.
3 · Its place in the literature

Who cites it

1,171 citing papers in PubMed, 4 syntheses or guidelines pooled it, 1,926 citations in OpenAlex.

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  20. A review of bloodstream infections-pathogens, pathogenesis, diagnostic strategies, treatment methods-challenges and future aspects.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2026
    Review

1,111 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors at 6 institutions in 4 countries.

Radha RajasinghamDivision of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA. Electronic address: radha@umn.edu.
Rachel M SmithMycotic Diseases Branch, Centers for Disease Control, Atlanta, GA, USA.
Benjamin J ParkMycotic Diseases Branch, Centers for Disease Control, Atlanta, GA, USA.
Joseph N JarvisDepartment of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; Botswana-University of Pennsylvania Partnership, Gaborone, Botswana; Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PA, USA; Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.
Nelesh P GovenderNational Institute for Communicable Diseases, Center for Healthcare-associated Infections, Antimicrobial Resistance and Mycoses, Johannesburg, South Africa; Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
Tom M ChillerMycotic Diseases Branch, Centers for Disease Control, Atlanta, GA, USA.
David W DenningUniversity of Manchester, Manchester Academic Health Science Centre and the National Aspergillosis Centre, University Hospital of South Manchester, Manchester, UK.
Angela LoyseCryptococcal Meningitis Group, Research Centre for Infection and Immunity, Division of Clinical Sciences, St George's University of London, London, UK.
David R BoulwareDivision of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
Centers for Disease Control and Prevention · USUniversity of Minnesota · USLondon School of Hygiene & Tropical Medicine · GBManchester Academic Health Science Centre · GBSt George's, University of London · GBUniversity of the Witwatersrand · ZA

Funding

University of Minnesota Clinical and Translational Science Institute (UMN CTSI)UL1TR000114 · NCATS · UNIVERSITY OF MINNESOTA · PI BLAZAR, BRUCE R · 2012 to 2015
$35.0M
Improving Diagnostics and Neurocognitive Outcomes in HIV/AIDS-related MeningitisR01NS086312 · NINDS · UNIVERSITY OF MINNESOTA · PI David R Boulware, David Bisagaya Meya · 2013 to 2026
$8.3M
Operational Research for Cryptococcal Antigen Screening (ORCAS) of HIV PatientsU01AI125003 · NIAID · UNIVERSITY OF MINNESOTA · PI BOULWARE, DAVID R, MEYA, DAVID BISAGAYA · 2016 to 2020
$3.4M
Phased Implementation of a Public Health Programme: Cryptococcal Screening and Treatment in South AfricaR01AI118511 · NIAID · UNIVERSITY OF MINNESOTA · PI BOULWARE, DAVID R, GOVENDER, NELESH PREMAPRAGASAN · 2016 to 2020
$2.9M
NCATS NIH HHS UL1 TR000114NIAID NIH HHS R01 AI118511NIAID NIH HHS U01 AI125003NINDS NIH HHS R01 NS086312
6 · The paper itself

Abstract

backgroundCryptococcus is the most common cause of meningitis in adults living with HIV in sub-Saharan Africa. Global burden estimates are crucial to guide prevention strategies and to determine treatment needs, and we aimed to provide an updated estimate of global incidence of HIV-associated cryptococcal disease.

methodsWe used 2014 Joint UN Programme on HIV and AIDS estimates of adults (aged >15 years) with HIV and antiretroviral therapy (ART) coverage. Estimates of CD4 less than 100 cells per μL, virological failure incidence, and loss to follow-up were from published multinational cohorts in low-income and middle-income countries. We calculated those at risk for cryptococcal infection, specifically those with CD4 less than 100 cells/μL not on ART, and those with CD4 less than 100 cells per μL on ART but lost to follow-up or with virological failure. Cryptococcal antigenaemia prevalence by country was derived from 46 studies globally. Based on cryptococcal antigenaemia prevalence in each country and region, we estimated the annual numbers of people who are developing and dying from cryptococcal meningitis.

findingsWe estimated an average global cryptococcal antigenaemia prevalence of 6·0% (95% CI 5·8-6·2) among people with a CD4 cell count of less than 100 cells per μL, with 278 000 (95% CI 195 500-340 600) people positive for cryptococcal antigen globally and 223 100 (95% CI 150 600-282 400) incident cases of cryptococcal meningitis globally in 2014. Sub-Saharan Africa accounted for 73% of the estimated cryptococcal meningitis cases in 2014 (162 500 cases [95% CI 113 600-193 900]). Annual global deaths from cryptococcal meningitis were estimated at 181 100 (95% CI 119 400-234 300), with 135 900 (75%; [95% CI 93 900-163 900]) deaths in sub-Saharan Africa. Globally, cryptococcal meningitis was responsible for 15% of AIDS-related deaths (95% CI 10-19).

interpretationOur analysis highlights the substantial ongoing burden of HIV-associated cryptococcal disease, primarily in sub-Saharan Africa. Cryptococcal meningitis is a metric of HIV treatment programme failure; timely HIV testing and rapid linkage to care remain an urgent priority.

fundingNone.

Indexed as

AdolescentAdultAgedAged, 80 and overAntigens, FungalAnti-Retroviral AgentsCD4 Lymphocyte CountFemaleGlobal Burden of DiseaseGlobal HealthHIV InfectionsHumansIncidenceLost to Follow-UpMaleMeningitis, CryptococcalAntigens, FungalAnti-Retroviral Agents

Identifiers

PMID28483415
PMCPMC5818156
OpenAlexW2611697423

What OpenQuestion holds

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Registered trials

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.