Cryptococcal Antigen Testing in Newly Diagnosed HIV-Positive Patients

In a prospective study from South Africa, lateral flow assay of serum, plasma, or whole blood for CrAg was positive in 4.3% of those with CD4 counts ≤100/µL. Despite antifungal therapy and absence of cryptococcal meningitis, mortality was significantly higher in the CrAg-positive group.

Detection of cryptococcal antigen (CrAg) in serum or plasma is a sensitive predictor of cryptococcal meningitis (CM). Retrospective observations suggest that routine CrAg screening and preemptive antifungal therapy for those who are positive could prevent subsequent CM.

To examine the effect of CrAg screening prospectively, 645 antiretroviral therapy (ART)-naive, HIV-infected patients with peripheral blood CD4 cell counts ≤100/µL in two South African clinics were screened for CrAg, first by serum latex agglutination (LA) and later by lateral flow assay (LFA) of serum, plasma, whole blood, and urine. ART was started within 2 to 4 weeks after CrAg screening. Twenty-eight patients (4.3%) were CrAg-positive by LFA. Results of serum, plasma, and …

Reviewing Author

Neil M. Ampel, MD

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Editorial BoardsUpToDate

Leadership Positions in Professional SocietiesCoccidioidomycosis Study Group (Past President, Secretary, Treasurer)

Neil M. Ampel, MD

Disclosures

Editorial BoardsUpToDate

Leadership Positions in Professional SocietiesCoccidioidomycosis Study Group (Past President, Secretary, Treasurer)

Cryptococcal Antigen Testing in Newly Diagnosed HIV-Positive Patients

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Reviewing Author