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

by Rita O. Oladele 1,2,3,†, Felix Bongomin 1,3,4,*,†, Sara Gago 1,3,5 and David W. Denning 1,3,4,5
1
Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
2
Department of Microbiology and Parasitology, College of Medicine, University of Lagos, Lagos ,P.O.Box 132, Nigeria
3
Global Action Fund for Fungal Infections, 1211 Geneva 1, Switzerland
4
The National Aspergillosis Center, Education and Research Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK
5
Manchester Fungal Infection Group, Core Technology Facility, The University of Manchester, Manchester M13 9PL, UK
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
J. Fungi 2017, 3(4), 67; https://doi.org/10.3390/jof3040067
Received: 2 November 2017 / Revised: 21 November 2017 / Accepted: 30 November 2017 / Published: 2 December 2017
(This article belongs to the Special Issue Cryptococcus and Cryptococcosis)
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. View Full-Text
Keywords: cryptococcal disease; resource-limited settings; cryptococcal polysaccharide capsular antigen (CrAg) test; prevention and treatment cryptococcal disease; resource-limited settings; cryptococcal polysaccharide capsular antigen (CrAg) test; prevention and treatment
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Oladele, R.O.; Bongomin, F.; Gago, S.; Denning, D.W. HIV-Associated Cryptococcal Disease in Resource-Limited Settings: A Case for “Prevention Is Better Than Cure”? J. Fungi 2017, 3, 67.

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