Table 2.
Outcomes of various cohorts of HIV-infected individuals with positive serum Cryptococcal antigen.
| Region | Country | Year | CD4+ T- cell count |
Prevalence | (n/N) | No Hx Crypto |
ASx | Other population information | Test Type |
Titer | Citation |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Mortality | |||||||||||
| Treated with anti-fungals | |||||||||||
| Phnom Phenh | Cambodia | 2004 | ≤200 | 20.0% | (2/10) | yes | no | ART naïve; negative workup; low dose fluconazole; | LA | 1:8 | (39) |
| Kampala | Uganda | 2004–6 | ≤100 | 28.6% | (6/21) | yes | yes | ART naïve; fluconazole | LA | NS | (30) |
| Kampala | Uganda | 2004–6 | 101–200 | 0.0% | (0/4) | yes | yes | ART naïve; fluconazole | LA | NS | (30) |
| Kisumu & Rongo | Kenya | 2010–11 | ≤100 | 39.0% | (23/59) | no | yes | ART naïve; high-dose fluconazole documented in 59%; sCrAg negative mortality 24% (107/455) | LA | 1:2 | (32) |
| Not treated with anti-fungals | |||||||||||
| Capetown | South Africa | 2002–5 | ≤200 | 34.1% | (14/41) | yes* | yes | ART naïve; sCrAg negative mortality 11% (64/574) | LA | 1:2 | (27) |
| Tororo | Uganda | 2003–4 | ≤100 | 22.7% | (5/22) | yes | yes | ART naïve; sCrAg negative mortality 5% (19/355) | LA | 1:2 | (28) |
| Kampala | Uganda | 2004–6 | ≤100 | 100.0% | (5/5) | yes | yes | ART naïve | LA | NS | (30) |
| Kampala | Uganda | 2004–6 | 101–200 | 33.3% | (1/3) | yes | yes | ART naïve | LA | NS | (30) |
| Addis Ababa | Ethiopia | 2011 | ≤200 | 9.7% | (3/31) | yes | no | 74% on ART; only 3 received antifungal; sCrAg negative dead or lost to follow up 12% (41/336) | LA | 1:2 | (47) |
| Incident Cryptococcal Meningitis | |||||||||||
| Treated with anti-fungals | |||||||||||
| Philadelphia | USA | ~1994 | ≤200 | 0.0% | (0/10) | NS | NS | ART naïve; negative workup; −4 Rx amphotericin; −4 Rx low dose fluconazole; −4 Rx itraconazole and fluconazole | NS | 1:8 | (45) |
| Los Angeles | USA | ~1996 | NS | 0.0% | (0/6) | no | no | ART naïve; negative workup; treated with fluconazole | LA+ EIA | 1:4 | (46) |
| Not treated with anti-fungals | |||||||||||
| Philadelphia | USA | ~1994 | ≤200 | 66.7% | (2/3) | NS | NS | ART naïve; negative workup | NS | 1:8 | (45) |
| Los Angeles | USA | ~1996 | NS | 100.0% | (1/1) | no | no | ART naïve; negative workup | LA+ EIA | 1:4 | (46) |
| Capetown | South Africa | 2002–5 | ≤100 | 28.6% | (6/21) | yes* | yes | ART naïve | LA | 1:2 | (27) |
| Tororo | Uganda | 2003–4 | ≤100 | 13.6% | (3/22) | yes | yes | ART naïve; 1%(4/355) sCrAg neg incident meningitis | LA | 1:2 | (28) |
Abbrev: ART: Anti-retroviral therapy; Asx: Asymptomatic; Crypto: cryptococcal disease; EIA: Enzyme Immunoassay; Hx: History; LA: Latex agglutination; LFA: Lateral Flow Assay; NS: Not specified; sCrAg: serum cryptococcal antigen; USA: United States of America.
Note: inpatient studies of cryptococcal antigenemia were not included in this table unless they specified ACA with negative diagnostic evaluation (negative workup).