ArticleJournal of acquired immune deficiency syndromes (1999)2019
Laboratory-Reflex Cryptococcal Antigen Screening Is Associated With a Survival Benefit in Tanzania.
Article in Journal of acquired immune deficiency syndromes (1999), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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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.
The trial behind it
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Who cites it
16 citing papers in PubMed, 23 citations in OpenAlex.
- Adjunctive Single-Dose Liposomal Amphotericin to Prevent Cryptococcal Meningitis in People With HIV-Associated Cryptococcal Antigenemia and Low Plasma Cryptococcal Antigen Titers.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025Trial
- Adjunctive sertraline for asymptomatic cryptococcal antigenemia: A randomized clinical trial.Medical mycology · 2020Trial
- Trial
- Clinical Impact and Cost-Effectiveness of Improving Access to Cryptococcal Meningitis Diagnostics and Treatment in Malawi.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Article
- 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
- Baseline C-reactive Protein as a Risk Factor for Cryptococcal Meningitis and Death in HIV-associated Cryptococcal Antigenemia With CrAg Titer as an Effect Modifier.Open forum infectious diseases · 2024Article
- Diagnosis and management of cryptococcal meningitis in HIV-infected adults.Clinical microbiology reviews · 2023Review
- Cryptococcal meningitis.Nature reviews. Disease primers · 2023Review
- Lack of education, knowledge, and supplies are barriers to cryptococcal meningitis care among nurses and other healthcare providers in rural Uganda: A mixed methods study.Nurse education today · 2023Article
- 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
- Outpatient Cryptococcal Antigen Screening Is Associated With Favorable Baseline Characteristics and Improved Survival in Persons With Cryptococcal Meningitis in Uganda.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Article
- Causes of death and associated factors over a decade of follow-up in a cohort of people living with HIV in rural Tanzania.BMC infectious diseases · 2022Article
- Cryptococcal Antigenemia in Human Immunodeficiency Virus Antiretroviral Therapy-Experienced Ugandans With Virologic Failure.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2020Article
- Potential missed opportunities for diagnosis of cryptococcosis and the association with mortality: A cohort study.EClinicalMedicine · 2020Article
- Review
- Cryptococcal Antigen Screening and Preemptive Treatment-How Can We Improve Survival?Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2020Article
Corrections and comments
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Authors and funding
11 authors at 6 institutions in 4 countries.
Funding
Abstract
backgroundCryptococcal antigen (CrAg) screening in persons with advanced HIV/AIDS is recommended to prevent death. Implementing CrAg screening only in outpatients may underestimate the true CrAg prevalence and decrease its potential impact. Our previous 12-month survival/retention in CrAg-positive persons not treated with fluconazole was 0%.
methodsHIV testing was offered to all antiretroviral therapy-naive outpatients and hospitalized patients in Ifakara, Tanzania, followed by laboratory-reflex CrAg screening for CD4 <150 cells/μL. CrAg-positive individuals were offered lumbar punctures, and antifungals were tailored to the presence/absence of meningitis. We assessed the impact on survival and retention-in-care using multivariate Cox-regression models.
resultsWe screened 560 individuals for CrAg. The median CD4 count was 61 cells/μL (interquartile range 26-103). CrAg prevalence was 6.1% (34/560) among individuals with CD4 ≤150 and 7.5% among ≤100 cells/μL. CrAg prevalence was 2.3-fold higher among hospitalized participants than in outpatients (12% vs 5.3%, P = 0.02). We performed lumbar punctures in 94% (32/34), and 31% (10/34) had cryptococcal meningitis. Mortality did not differ significantly between treated CrAg-positive without meningitis and CrAg-negative individuals (7.3 vs 5.4 deaths per 100 person-years, respectively, P = 0.25). Independent predictors of 6-month death/lost to follow-up were low CD4, cryptococcal meningitis (adjusted hazard ratio 2.76, 95% confidence interval: 1.31 to 5.82), and no antiretroviral therapy initiation (adjusted hazard ratio 3.12, 95% confidence interval: 2.16 to 4.50).
conclusionsImplementing laboratory-reflex CrAg screening among outpatients and hospitalized individuals resulted in a rapid detection of cryptococcosis and a survival benefit. These results provide a model of a feasible, effective, and scalable CrAg screening and treatment strategy integrated into routine care in sub-Saharan Africa.
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