Evidence map›Paper›PMID 34101629›Full record

ArticleAIDS (London, England)2021

Survival following screening and preemptive antifungal therapy for subclinical cryptococcal disease in advanced HIV infection.

Tariro Azure Makadzange, Admire Hlupeni, Rhoderick Machekano, Kathryn Boyd, Takudzwa Mtisi, Primrose Nyamayaro, Christine Ross, Snighdha Vallabhaneni, Shirish Balachandra, Prosper Chonzi and 1 more

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in AIDS (London, England), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
0.6field-weighted citation impact, top 32% 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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 8 citations in OpenAlex.

  1. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 3 institutions in 3 countries.

Tariro Azure MakadzangeDepartment of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
Admire HlupeniDepartment of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
Rhoderick MachekanoDivision of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
Kathryn BoydDepartment of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
Takudzwa MtisiDepartment of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
Primrose NyamayaroDepartment of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
Christine RossUS Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Snighdha VallabhaneniUS Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Shirish BalachandraUS Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Prosper ChonziHealth Services Department, City of Harare, Harare, Zimbabwe.
Chiratidzo Ellen NdhlovuDepartment of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
University of Zimbabwe · ZWCenters for Disease Control and Prevention · USStellenbosch University · ZA

Funding

Determinants of Immune Control in HIV perinatally infected children in sub-SaharaK08AI104348 · NIAID · MASSACHUSETTS GENERAL HOSPITAL · PI MAKADZANGE, AZURE TARIRO · 2013 to 2016
$745k
CGH CDC HHS U01 GH000737NIAID NIH HHS K08 AI104348
6 · The paper itself

Abstract

objectivesOur study's primary objective was to compare 1-year survival rates between serum cryptococcal antigen (sCrAg)-positive and sCrAg-negative HIV-positive individuals with CD4+ cell counts less than 100 cells/μl without symptoms of meningitis in Zimbabwe.

designThis was a prospective cohort study.

methodsParticipants were enrolled as either sCrAg-positive or sCrAg-negative and followed up for 52 weeks or less, with death as the outcome. Lumbar punctures were recommended to all sCrAg-positives and inpatient management with intravenous amphotericin B and high-dose fluconazole was recommended to those with disseminated Cryptococcus. Antiretroviral therapy was initiated immediately in sCrAg-negatives and after at least 4 weeks following initiation of antifungals in sCrAg-positives. Multivariable logistic regression models were used to determine risk factors for mortality.

resultsWe enrolled 1320 participants and 130 (9.8%) were sCrAg positive, with a median sCrAg titre of 1 : 20. Sixty-six (50.8%) sCrAg-positives had lumbar punctures and 16.7% (11/66) had central nervous system (CNS) dissemination. Cryptococcal blood cultures were performed in 129 sCrAg-positives, with 10 (7.8%) being positive. One-year (48-52 weeks) survival rates were 83.9 and 76.1% in sCrAg-negatives and sCrAg-positives, respectively, P = 0.011. Factors associated with increased mortality were a positive sCrAg, CD4+ cell count less than 50 cells/μl and having presumptive tuberculosis (TB) symptoms.

conclusionOur study reports a high prevalence of subclinical cryptococcal antigenemia and reiterates the importance of TB and a positive sCrAg as risk factors for mortality in advanced HIV disease (AHD). Therefore, TB and sCrAg screening remains a crucial component of AHD package, hence it should always be part of the comprehensive clinical evaluation in AHD patients.

Indexed as

AIDS-Related Opportunistic InfectionsCryptococcusHIV InfectionsMeningitis, CryptococcalAntifungal AgentsAntigens, FungalCD4 Lymphocyte CountHumansProspective StudiesAntifungal AgentsAntigens, Fungal

Identifiers

PMID34101629
PMCPMC8416705
OpenAlexW3167100083

What OpenQuestion holds

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Registered trials

None linked

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.