SynthesisClinical infectious diseases : an official publication of the Infectious Diseases Society of America2018
CD4 Cell Count Threshold for Cryptococcal Antigen Screening of HIV-Infected Individuals: A Systematic Review and Meta-analysis.
Synthesis in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 60 papers, 3 of them syntheses that pooled it.
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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.
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Who cites it
60 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Pooled it
- Cryptococcal antigenemia and its predictors among HIV infected patients in resource limited settings: a systematic review.BMC infectious diseases · 2020Pooled it
- Magnitude ofAfrican health sciences · 2020Pooled it
- Acute ischemic stroke revealing cryptococcal meningitis in an HIV-infected patient with a relatively preserved CD4 count: a case report.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026Article
- Data-driven Modeling of Long-term CD4 Cell Recovery Trajectories Under Modern Antiretroviral Therapy in People Living With HIV.Open forum infectious diseases · 2026Article
- Research priorities for advanced HIV disease in Latin America and the Caribbean region: a modified Delphi study.Journal of the International AIDS Society · 2026Article
- Article
- Ten years on: Ongoing challenges in screening for cryptococcal antigenaemia in people with advanced HIV disease in South Africa.Southern African journal of HIV medicine · 2026Article
- Factors associated with cryptococcal capsular antigen positivity among people living with HIV: a retrospective observational cohort study.BMC infectious diseases · 2025Observational
- Clinical impact and cost-effectiveness of the WHO-recommended advanced HIV disease package of care.The Lancet. Global health · 2025Article
- Reframing the clinical phenotype and management of cryptococcal meningitis.Practical neurology · 2025Review
- Reflexed cryptococcal antigenaemia detection rates in the Western Cape, South Africa.Southern African journal of HIV medicine · 2025Article
- Metagenomic next-generation sequencing for cryptococcal meningitis diagnosis: a single-center experience.Frontiers in cellular and infection microbiology · 2025Article
- Screening for cryptococcal antigenemia and meningeal cryptococcosis, genetic characterization of Cryptococcus neoformans in asymptomatic patients with advanced HIV disease in Kinshasa, Democratic Republic of Congo.Scientific reports · 2024Article
- Prevalence of Cryptococcal Antigenemia and Lateral Flow Assay Accuracy in Severely Immunosuppressed AIDS Patients.Journal of fungi (Basel, Switzerland) · 2024Article
- Economic impact of extending reflexed cryptococcal antigenaemia CD4 threshold in South Africa.Southern African journal of HIV medicine · 2024Article
- Diagnosis and management of cryptococcal meningitis in HIV-infected adults.Clinical microbiology reviews · 2023Review
- Cryptococcal meningitis.Nature reviews. Disease primers · 2023Review
- Ending AIDS deaths requires improvements in clinical care for people with advanced HIV disease who are seriously ill.The lancet. HIV · 2023Review
- Article
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
Background: Current guidelines recommend screening all people living with human immunodeficiency virus (PLHIV) who have a CD4 count ≤100 cells/µL for cryptococcal antigen (CrAg) to identify those patients who could benefit from preemptive fluconazole treatment prior to the onset of meningitis. We conducted a systematic review to assess the prevalence of CrAg positivity at different CD4 cell counts. Methods: We searched 4 databases and abstracts from 3 conferences up to 1 September 2017 for studies reporting prevalence of CrAg positivity according to CD4 cell count strata. Prevalence estimates were pooled using random effects models. Results: Sixty studies met our inclusion criteria. The pooled prevalence of cryptococcal antigenemia was 6.5% (95% confidence interval [CI], 5.7%-7.3%; 54 studies) among patients with CD4 count ≤100 cells/µL and 2.0% (95% CI, 1.2%-2.7%; 21 studies) among patients with CD4 count 101-200 cells/µL. Twenty-one studies provided sufficient information to compare CrAg prevalence per strata; overall, 18.6% (95% CI, 15.4%-22.2%) of the CrAg-positive cases identified at ≤200 cells/µL (n = 11823) were identified among individuals with a CD4 count 101-200 cells/µL. CrAg prevalence was higher among inpatients (9.8% [95% CI, 4.0%-15.5%]) compared with outpatients (6.3% [95% CI, 5.3%-7.4%]). Conclusions: The findings of this review support current recommendations to screen all PLHIV who have a CD4 count ≤100 cells/µL for CrAg and suggest that screening may be considered at CD4 cell count ≤200 cells/µL.
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