ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2020
Cryptococcal-related Mortality Despite Fluconazole Preemptive Treatment in a Cryptococcal Antigen Screen-and-Treat Program.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 38 papers.
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.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
38 citing papers in PubMed, 57 citations in OpenAlex.
- Trial
- Cytomegalovirus Viremia Is Strongly Associated With 6-Month Mortality Among Adults Living With Advanced HIV Disease: A Prospective Cohort Study in South Africa.Open forum infectious diseases · 2026Article
- Prevalence of Fungemia in People with HIV: A Systematic Review and Meta-Analysis.Microorganisms · 2026Review
- 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
- Comparative Analysis of Glucuronoxylomannogalactan and Glucuronoxylomannan Antibody Responses and Their Associations With Cryptococcal Disease Status in People With HIV.The Journal of infectious diseases · 2025Article
- 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
- Review
- Impact of cerebrospinal fluid leukocyte infiltration and activated neuroimmune mediators on survival with HIV-associated cryptococcal meningitis.PLoS neglected tropical diseases · 2025Article
- High Cryptococcal Antigenuria Prevalence in a Population of PLHIV with Neurological Symptoms Hospitalized in the Infectious Diseases Wards of the Centre Hospitalier Universitaire de Libreville, Gabon.Tropical medicine and infectious disease · 2024Article
- Article
- Prevalence of Cryptococcal Antigenemia and Lateral Flow Assay Accuracy in Severely Immunosuppressed AIDS Patients.Journal of fungi (Basel, Switzerland) · 2024Article
- Impact of Cerebrospinal Fluid Leukocyte Infiltration and Neuroimmmune Mediators on Survival with HIV-Associated Cryptococcal Meningitis.medRxiv : the preprint server for health sciences · 2024Article
- Frequency of fungal pathogens in autopsy studies of people who died with HIV in Africa: a scoping review.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2024Article
- Diagnosis and management of cryptococcal meningitis in HIV-infected adults.Clinical microbiology reviews · 2023Review
- Cryptococcal meningitis.Nature reviews. Disease primers · 2023Review
- Preemptive Therapy in Cryptococcosis Adjusted for Outcomes.Journal of fungi (Basel, Switzerland) · 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
- Divergent neuroimmune signatures in the cerebrospinal fluid predict differential gender-specific survival among patients with HIV-associated cryptococcal meningitis.Frontiers in immunology · 2023Article
Corrections and comments
- Commented on by
- Erratum issued
Authors and funding
10 authors at 8 institutions in 4 countries.
Funding
Abstract
backgroundCryptococcal antigen (CrAg) screening and treatment with preemptive fluconazole reduces the incidence of clinically evident cryptococcal meningitis in individuals living with advanced human immunodeficiency virus (HIV) disease. However, mortality remains higher in CrAg-positive than in CrAg-negative patients with similar CD4+ T-lymphocyte counts.
methodsWe conducted a cohort study to investigate causes of morbidity and mortality during 6 months of follow-up among asymptomatic CrAg-positive and CrAg-negative (ratio of 1:2) patients living with HIV with CD4 counts <100 cells/µL attending 2 hospitals in Johannesburg, South Africa. When possible, minimally invasive autopsy (MIA) was performed on participants who died.
resultsSixty-seven CrAg-positive and 134 CrAg-negative patients were enrolled. Death occurred in 17/67 (25%) CrAg-positive and 12/134 (9%) CrAg-negative participants (hazard ratio for death, adjusted for CD4 count, 3.0; 95% confidence interval, 1.4-6.7; P = .006). Cryptococcal disease was an immediate or contributing cause of death in 12/17 (71%) CrAg-positive participants. Postmortem cryptococcal meningitis and pulmonary cryptococcosis were identified at MIA in all 4 CrAg-positive participants, 3 of whom had negative cerebrospinal fluid CrAg tests from lumbar punctures (LPs) at the time of CrAg screening.
conclusionsCryptococcal disease was an important cause of mortality among asymptomatic CrAg-positive participants despite LPs to identify and treat those with subclinical cryptococcal meningitis and preemptive fluconazole for those without meningitis. Thorough investigation for cryptococcal disease with LPs and blood cultures, prompt ART initiation, and more intensive antifungals may reduce mortality among asymptomatic CrAg-positive patients identified through screening.
Indexed as
Identifiers
What OpenQuestion holds
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.