Any Benefit of Additional Therapy to Prevent Cryptococcal Meningitis in Patients with HIV Infection and Low-Titer Cryptococcal Antigenemia?

Cryptococcal meningitis (CM) remains the leading cause of AIDS-related mortality. That risk can be reduced by obtaining a plasma cryptococcal antigen (CrAg) and, if CrAg is positive, treating the patient with fluconazole for 24 weeks. However, even with this approach, mortality remains 50% higher than in CrAg-negative patients, with the risk for death greatest in patients with CrAg titers ≥1:160.

To assess the potential benefit of a single dose of liposomal amphotericin B (LAmB) in patients with positive plasma CrAg who are asymptomatic for CM, investigators in Uganda randomized 251 persons with HIV and asymptomatic cryptococcal antigenemia to receive 10 mg/kg LAmB intravenously once, followed by fluconazole, or to receive fluconazole alone …