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Preventing Cryptococcosis—Shifting the Paradigm in the Era of Highly Active Antiretroviral Therapy

Cryptococcosis remains a significant cause of morbidity and mortality among HIV-infected patients, especially in sub-Saharan Africa where it causes up to 20 % of AIDS-related deaths in HIV programs. A new, highly sensitive, and affordable point of care diagnostic test for cryptococcal infection, the...

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Autores principales: Meya, David, Rajasingham, Radha, Nalintya, Elizabeth, Tenforde, Mark, Jarvis, Joseph N
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4412515/
https://www.ncbi.nlm.nih.gov/pubmed/25960942
http://dx.doi.org/10.1007/s40475-015-0045-z
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author Meya, David
Rajasingham, Radha
Nalintya, Elizabeth
Tenforde, Mark
Jarvis, Joseph N
author_facet Meya, David
Rajasingham, Radha
Nalintya, Elizabeth
Tenforde, Mark
Jarvis, Joseph N
author_sort Meya, David
collection PubMed
description Cryptococcosis remains a significant cause of morbidity and mortality among HIV-infected patients, especially in sub-Saharan Africa where it causes up to 20 % of AIDS-related deaths in HIV programs. A new, highly sensitive, and affordable point of care diagnostic test for cryptococcal infection, the lateral flow assay, can detect early sub-clinical cryptococcosis especially in areas with limited laboratory infrastructure. With a prevalence of detectable sub-clinical cryptococcal infection averaging 7.2 % (95 % CI 6.8–7.6 %) among 36 cohorts with CD4 <100 cells/μL in Africa, together with data showing that preemptive fluconazole prevents overt cryptococcal disease in this population, implementing a screen and treat strategy as part of HIV care practice among patients with CD4 <100 cells/μL could prevent the incidence of often fatal cryptococcal meningitis in the setting of the HIV pandemic.
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spelling pubmed-44125152015-05-06 Preventing Cryptococcosis—Shifting the Paradigm in the Era of Highly Active Antiretroviral Therapy Meya, David Rajasingham, Radha Nalintya, Elizabeth Tenforde, Mark Jarvis, Joseph N Curr Trop Med Rep Tropical Mycosis (D Boulware, Section Editor) Cryptococcosis remains a significant cause of morbidity and mortality among HIV-infected patients, especially in sub-Saharan Africa where it causes up to 20 % of AIDS-related deaths in HIV programs. A new, highly sensitive, and affordable point of care diagnostic test for cryptococcal infection, the lateral flow assay, can detect early sub-clinical cryptococcosis especially in areas with limited laboratory infrastructure. With a prevalence of detectable sub-clinical cryptococcal infection averaging 7.2 % (95 % CI 6.8–7.6 %) among 36 cohorts with CD4 <100 cells/μL in Africa, together with data showing that preemptive fluconazole prevents overt cryptococcal disease in this population, implementing a screen and treat strategy as part of HIV care practice among patients with CD4 <100 cells/μL could prevent the incidence of often fatal cryptococcal meningitis in the setting of the HIV pandemic. Springer International Publishing 2015-04-21 2015 /pmc/articles/PMC4412515/ /pubmed/25960942 http://dx.doi.org/10.1007/s40475-015-0045-z Text en © The Author(s) 2015 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Tropical Mycosis (D Boulware, Section Editor)
Meya, David
Rajasingham, Radha
Nalintya, Elizabeth
Tenforde, Mark
Jarvis, Joseph N
Preventing Cryptococcosis—Shifting the Paradigm in the Era of Highly Active Antiretroviral Therapy
title Preventing Cryptococcosis—Shifting the Paradigm in the Era of Highly Active Antiretroviral Therapy
title_full Preventing Cryptococcosis—Shifting the Paradigm in the Era of Highly Active Antiretroviral Therapy
title_fullStr Preventing Cryptococcosis—Shifting the Paradigm in the Era of Highly Active Antiretroviral Therapy
title_full_unstemmed Preventing Cryptococcosis—Shifting the Paradigm in the Era of Highly Active Antiretroviral Therapy
title_short Preventing Cryptococcosis—Shifting the Paradigm in the Era of Highly Active Antiretroviral Therapy
title_sort preventing cryptococcosis—shifting the paradigm in the era of highly active antiretroviral therapy
topic Tropical Mycosis (D Boulware, Section Editor)
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4412515/
https://www.ncbi.nlm.nih.gov/pubmed/25960942
http://dx.doi.org/10.1007/s40475-015-0045-z
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