title: Strategies to reduce mortality and morbidity due to AIDS-related cryptococcal meningitis in Latin America.
abstract: Latin America is the region with the third most AIDS-related cryptococcal meningitis infections globally. Highly active antiretroviral therapy (HAART) has reduced the number of infections; however, the number of deaths and the case-fatality rate continues to be unacceptable. In this review, we focus on the burden of AIDS-related cryptococcosis in Latin America and discuss potential strategies to reduce early mortality from Cryptococcus. In this review, we highlight the importance of: (1) earlier HIV diagnosis and HAART initiation with retention-in-care to avoid AIDS; (2) pre-HAART cryptococcal antigen (CRAG) screening with preemptive fluconazole treatment; (3) better diagnostics (e.g. CRAG testing); and (4) optimal treatment with aggressive management of intracranial pressure and induction therapy with antifungal combination. Implementation of these strategies can reduce cryptococcal-related deaths, improve care, and reduce healthcare costs.
authors.affiliation: Department of Infectious Diseases, Instituto de Infectologia Emilio Ribas, São Paulo, SP, Brazil. josevibe@gmail.com
authors.forename: Jose E
authors.initials: JE
authors.lastname: Vidal
authors.forename: Augusto C
authors.initials: AC
authors.lastname: Penalva de Oliveira
authors.forename: Rafi F
authors.initials: RF
authors.lastname: Dauar
authors.forename: David R
authors.initials: DR
authors.lastname: Boulware
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000401:mortality*; D000935:Antifungal Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D016919:Meningitis, Cryptococcal / Q000188:drug therapy / Q000401:mortality*
chemical_list: D000935:Antifungal Agents