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Cited by 113Fungal Infections and StudiesPneumocystis jirovecii pneumonia detection and treatmentAntifungal resistance and susceptibility

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CD4 Cell Count Threshold for Cryptococcal Antigen Screening of HIV-Infected Individuals: A Systematic Review and Meta-analysis

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Ford, Nathan, Shubber, Zara, Jarvis, Joseph N, Chiller, Tom, Greene, Greg, Migone, Chantal, Vitoria, Marco, Doherty, Meg, Meintjes, Graeme·2018·Clinical Infectious Diseases
DOI 10.1093/cid/cix1143PMC PMC5850628
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Abstract

Background: Current guidelines recommend screening all people living with human immunodeficiency virus (PLHIV) who have a CD4 count ≤100 cells/µL for cryptococcal antigen (CrAg) to identify those patients who could benefit from preemptive fluconazole treatment prior to the onset of meningitis. We conducted a systematic review to assess the prevalence of CrAg positivity at different CD4 cell counts. Methods: We searched 4 databases and abstracts from 3 conferences up to 1 September 2017 for studies reporting prevalence of CrAg positivity according to CD4 cell count strata. Prevalence estimates were pooled using random effects models. Results: Sixty studies met our inclusion criteria. The pooled prevalence of cryptococcal antigenemia was 6.5% (95% confidence interval [CI], 5.7%-7.3%; 54 studies) among patients with CD4 count ≤100 cells/µL and 2.0% (95% CI, 1.2%-2.7%; 21 studies) among patients with CD4 count 101-200 cells/µL. Twenty-one studies provided sufficient information to compare CrAg prevalence per strata; overall, 18.6% (95% CI, 15.4%-22.2%) of the CrAg-positive cases identified at ≤200 cells/µL (n = 11823) were identified among individuals with a CD4 count 101-200 cells/µL. CrAg prevalence was higher among inpatients (9.8% [95% CI, 4.0%-15.5%]) compared with outpatients (6.3% [95% CI, 5.3%-7.4%]). Conclusions: The findings of this review support current recommendations to screen all PLHIV who have a CD4 count ≤100 cells/µL for CrAg and suggest that screening may be considered at CD4 cell count ≤200 cells/µL.

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  • Published guidelines for the management of community acquired pneumonia recommend initiation of antimicrobials for patients with community acquired pneumonia regardless of procalcitonin level.

    “Published guidelines for the management of community acquired pneumonia recommend initiation of antimicrobials for patients with community acquired pneumonia regardless of procalcitonin level (132).”

    From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [132]

    The Background and Discussion address cryptococcal antigen screening in people living with HIV, not treatment of community-acquired pneumonia. Searches for pneumonia guidelines and procalcitonin-based antimicrobial initiation found no passage addressing the claim in our copy. (LLM, conf=0.78)

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Metadata

Authors
Ford, N., Shubber, Z., Jarvis, J. N., Chiller, T., Greene, G., Migone, C., Vitoria, M., Doherty, M., & Meintjes, G.
Affiliations
  • World Health Organization (CH)
  • Imperial College London (GB)
  • London School of Hygiene & Tropical Medicine (GB)
  • Centers for Disease Control and Prevention (US)
  • HIV Department, World Health Organization, Geneva, Switzerland
  • University of Cape Town (ZA)
Corresponding author
Ford, Nathan
ORCID
Venue
Clinical Infectious Diseases
Publisher
Oxford University Press (OUP)
Published
2018-03-04
Volume
66
Issue
suppl_2
Pages
S152-S159
ISSN
  • 1058-4838 (ISSN-L)
  • 1537-6591
DOI
10.1093/cid/cix1143
PMC
PMC5850628
OpenAlex
W2789522295
Cited by
113
References
1
Citations by year
2026: 6 · 2025: 10 · 2024: 8 · 2023: 13 · 2022: 14 · 2021: 19 · 2020: 21 · 2019: 13 · 2018: 9
FWCI
2.21
Type
journal article
Language
en
Open access
Licence
Locations
  • Clinical Infectious Diseases (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • Greater South Information System
Funders
  • Wellcome Trust (098316)
  • South African Research Chairs Initiative of the Department of Science and Technology
  • National Research Foundation of South Africa (64787)
  • National Institutes of Health (P30 AI 045008)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Fungal Infections and Studies
  • Health Sciences › Medicine › Epidemiology › Pneumocystis jirovecii pneumonia detection and treatment
  • Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
Keywords
cryptococcal antigenemia, cryptococcal meningitis, HIV, CD4 count, screening thresholds, inpatients versus outpatients
MeSH terms
Antigens, Fungal, Cryptococcosis, Cryptococcus, HIV, Humans, Mass Screening, HIV Infections, Prevalence, Meningitis, Cryptococcal, AIDS-Related Opportunistic Infections, CD4 Lymphocyte Count, Anti-HIV Agents

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