title: The changing epidemiology of cryptococcosis: an update from population-based active surveillance in 2 large metropolitan areas, 1992-2000.
abstract: To examine trends in the incidence and epidemiology of cryptococcosis, active, population-based surveillance was conducted during 1992-2000 in 2 areas of the United States (the Atlanta, Georgia, and Houston, Texas, metropolitan areas; combined population, 7.4 million). A total of 1491 incident cases were detected, of which 1322 (89%) occurred in HIV-infected persons. The annual incidence of cryptococcosis per 1000 persons with AIDS decreased significantly during the study period, from 66 in 1992 to 7 in 2000 in the Atlanta area, and from 24 in 1993 to 2 in 1994 in the Houston area. Poisson regression analysis revealed that African American persons with AIDS were more likely than white persons with AIDS to develop disease. Less than one-third of all HIV-infected persons with cryptococcosis were receiving antiretroviral therapy before diagnosis. Our findings suggest that HIV-infected persons who continue to develop cryptococcosis in the era of highly active antiretroviral therapy (HAART) in the United States are those with limited access to health care. More efforts are needed to expand the availability of HAART and routine HIV care services to these persons.
authors.affiliation: Mycotic Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
authors.forename: Sara A
authors.initials: SA
authors.lastname: Mirza
authors.forename: Maureen
authors.initials: M
authors.lastname: Phelan
authors.forename: David
authors.initials: D
authors.lastname: Rimland
authors.forename: Edward
authors.initials: E
authors.lastname: Graviss
authors.forename: Richard
authors.initials: R
authors.lastname: Hamill
authors.forename: Mary E
authors.initials: ME
authors.lastname: Brandt
authors.forename: Tracie
authors.initials: T
authors.lastname: Gardner
authors.forename: Matthew
authors.initials: M
authors.lastname: Sattah
authors.forename: Gabriel Ponce
authors.initials: GP
authors.lastname: de Leon
authors.forename: Wendy
authors.initials: W
authors.lastname: Baughman
authors.forename: Rana A
authors.initials: RA
authors.lastname: Hajjeh
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000382:microbiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003453:Cryptococcosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome