HIV-Associated Cryptococcal Disease in Resource-Limited Settings: A Case for "Prevention Is Better Than Cure"?

被引:26
作者
Oladele, Rita O. [1 ,2 ,3 ]
Bongomin, Felix [1 ,3 ,4 ]
Gago, Sara [1 ,3 ,5 ]
Denning, David W. [1 ,3 ,4 ,5 ]
机构
[1] Univ Manchester, Fac Biol Med & Hlth, Div Infect Immun & Resp Med, Manchester M13 9PL, Lancs, England
[2] Univ Lagos, Dept Microbiol & Parasitol, Coll Med, POB 132, Lagos, Nigeria
[3] Global Act Fund Fungal Infect, CH-1211 Geneva 1, Switzerland
[4] Manchester Univ NHS Fdn Trust, Wythenshawe Hosp, Educ & Res Ctr, Natl Aspergillosis Ctr, Manchester M23 9LT, Lancs, England
[5] Univ Manchester, Core Technol Facil, Manchester Fungal Infect Grp, Manchester M13 9PL, Lancs, England
基金
英国国家替代、减少和改良动物研究中心;
关键词
cryptococcal disease; resource-limited settings; cryptococcal polysaccharide capsular antigen (CrAg) test; prevention and treatment; LATERAL FLOW ASSAY; RECONSTITUTION INFLAMMATORY SYNDROME; INVASIVE FUNGAL-INFECTIONS; PLACEBO-CONTROLLED TRIAL; HIGH-DOSE FLUCONAZOLE; AIDS PATIENTS; AMPHOTERICIN-B; ANTIRETROVIRAL THERAPY; GLOBAL BURDEN; DOUBLE-BLIND;
D O I
10.3390/jof3040067
中图分类号
Q93 [微生物学];
学科分类号
071005 ; 100705 ;
摘要
Cryptococcal disease remains a significant source of global morbidity and mortality for people living with HIV, especially in resource-limited settings. The recently updated estimate of cryptococcal disease revealed a global incidence of 223,100 cases annually with 73% of these cases being diagnosed in sub-Saharan Africa. Furthermore, 75% of the estimated 181,100 deaths associated with cryptococcal disease occur in sub-Saharan Africa. Point-of-care diagnostic assays have revolutionised the diagnosis of this deadly opportunistic infection. The theory of asymptomatic cryptococcal antigenaemia as a forerunner to symptomatic meningitis and death has been conclusively proven. Thus, cryptococcal antigenaemia screening coupled with pre-emptive antifungal therapy has been demonstrated as a cost-effective strategy with survival benefits and has been incorporated into HIV national guidelines in several countries. However, this is yet to be implemented in a number of other high HIV burden countries. Flucytosine-based combination therapy during the induction phase is associated with improved survival, faster cerebrospinal fluid sterilisation and fewer relapses. Flucytosine, however, is unavailable in many parts of the world. Studies are ongoing on the efficacy of shorter regimens of amphotericin B. Early diagnosis, proactive antifungal therapy with concurrent management of raised intracranial pressure creates the potential to markedly reduce mortality associated with this disease.
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页数:18
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