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Impact of routine cryptococcal antigen screening and targeted pre-emptive fluconazole therapy in antiretroviral naive HIV-infected adults with less than 100 CD4 cells/μL: a systematic review and meta-analysis.

Temfack, E; Bigna, JJ; Luma, HN; Spijker, R; Meintjes, G; Jarvis, JN; Dromer, F; Harrison, T; Cohen, JF; Lortholary, O (2019) Impact of routine cryptococcal antigen screening and targeted pre-emptive fluconazole therapy in antiretroviral naive HIV-infected adults with less than 100 CD4 cells/μL: a systematic review and meta-analysis. Clin Infect Dis, 68 (4). pp. 688-698. ISSN 1537-6591 https://doi.org/10.1093/cid/ciy567
SGUL Authors: Harrison, Thomas Stephen

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Abstract

Cryptococcal antigen (CrAg) screening and targeted pre-emptive fluconazole in antiretroviral naive HIV-infected adults with less than 100 CD4 cells/μL seems promising to reduce the burden of cryptococcal meningitis (CM). We searched MEDLINE, EMBASE, and Web of Science and used random-effect meta-analysis to assess the prevalence of blood CrAg-positivity (31 studies; 35,644 participants) and asymptomatic CM in CrAg-positives, incidence of CM and all-cause mortality in screened participants. Pooled prevalence of blood CrAg-positivity was 6% (95%CI: 5 - 7) and asymptomatic CM in CrAg-positives was 33% (95%CI: 21 - 45). Incidence of CM without pre-emptive fluconazole was 21.4% (95%CI: 11.6 - 34.4) and 5.7% (95%CI: 3.0 - 9.7) with pre-emptive fluconazole initiated at 800 mg/day. In CrAg-positives, post-screening lumbar puncture prior to initiating pre-emptive fluconazole at 800 mg/day further reduced incidence of CM to null and showed some survival benefits. However, all-cause mortality remained significantly higher in CrAg-positives than CrAg-negatives: RR: 2.2 (95%CI: 1.7 - 2.9, p<0.001).

Item Type: Article
Additional Information: This is a pre-copyedited, author-produced version of an article accepted for publication in Clinical Infectious Diseases following peer review. The version of record Elvis Temfack, Jean Joel Bigna, Henry N Luma, Rene Spijker, Graeme Meintjes, Joseph N Jarvis, Françoise Dromer, Thomas Harrison, Jérémie F Cohen, Olivier Lortholary; Impact of Routine Cryptococcal Antigen Screening and Targeted Preemptive Fluconazole Therapy in Antiretroviral-naive Human Immunodeficiency Virus–infected Adults With CD4 Cell Counts <100/μL: A Systematic Review and Meta-analysis, Clinical Infectious Diseases, Volume 68, Issue 4, 1 February 2019, Pages 688–698 is available online at: https://doi.org/10.1093/cid/ciy567
Keywords: Microbiology, 06 Biological Sciences, 11 Medical And Health Sciences
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: Clin Infect Dis
ISSN: 1537-6591
Language: eng
Dates:
DateEvent
15 February 2019Published
18 July 2018Published Online
7 July 2018Accepted
Publisher License: Publisher's own licence
Projects:
Project IDFunderFunder ID
33/CSS6/AO 2013-1French National Agency for HIV and Hepatitis ResearchUNSPECIFIED
PubMed ID: 30020446
Go to PubMed abstract
URI: http://openaccess.sgul.ac.uk/id/eprint/110137
Publisher's version: https://doi.org/10.1093/cid/ciy567

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