title: Utility of Cryptococcal Antigen Screening and Evolution of Asymptomatic Cryptococcal Antigenemia among HIV-Infected Women Starting Antiretroviral Therapy in Thailand.
abstract: Cryptococcal meningitis (CM) remains a significant HIV-associated opportunistic infection in Southeast Asia and Africa, with a high burden of disease and a high mortality rate despite the availability of antiretroviral therapy (ART). We retrospectively examined the utility of cryptococcal antigen screening to identify risk for CM among 211 Thai women initiating ART. Antigenemia prevalence was 11% (n = 9) among 84 women with a CD4 count <100 cells/mm(3). Screening identified all women who later developed CM. Cryptococcal antigen titers decreased over time with ART. Our study confirmed findings from previous studies in Thailand and South Africa and provided novel observational data regarding the course of cryptococcal antigenemia in patients initiating ART and the poor efficacy of low-dose fluconazole prophylaxis in preventing CM among patients with antigenemia.
authors.affiliation: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA Epidemic Intelligence Service, CDC, Atlanta, GA, USA candicekwan@post.harvard.edu.
authors.forename: Candice K
authors.initials: CK
authors.lastname: Kwan
authors.affiliation: Thailand Ministry of Public Health-US CDC Collaboration, Nonthaburi, Thailand.
authors.forename: Wanna
authors.initials: W
authors.lastname: Leelawiwat
authors.affiliation: Infectious Diseases Unit, Rajavithi Hospital, Bangkok, Thailand.
authors.forename: Poj
authors.initials: P
authors.lastname: Intalapaporn
authors.affiliation: Department of Preventive and Social Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Thanomsak
authors.initials: T
authors.lastname: Anekthananon
authors.affiliation: Thailand Ministry of Public Health-US CDC Collaboration, Nonthaburi, Thailand.
authors.forename: Boonyos
authors.initials: B
authors.lastname: Raengsakulrach
authors.affiliation: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Peters
authors.affiliation: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
authors.forename: Janet M
authors.initials: JM
authors.lastname: McNicholl
authors.affiliation: Mycotic Diseases Branch, CDC, Atlanta, GA, USA.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Park
authors.affiliation: Thailand Ministry of Public Health-US CDC Collaboration, Nonthaburi, Thailand.
authors.forename: Michelle S
authors.initials: MS
authors.lastname: McConnell
authors.affiliation: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Weidle
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D000946:Antigens, Fungal / Q000097:blood*; D018791:CD4 Lymphocyte Count; D003454:Cryptococcus / Q000302:isolation & purification; D016469:Fungemia / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D016919:Meningitis, Cryptococcal / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D012189:Retrospective Studies; D013785:Thailand / Q000453:epidemiology
chemical_list: D044966:Anti-Retroviral Agents; D000946:Antigens, Fungal
keywords: HIV; cryptococcal antigen; cryptococcal meningitis; cryptococcus; screening