title: Primary prophylaxis for cryptococcal meningitis and impact on mortality in HIV: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To determine the role of primary antifungal prophylaxis in the prevention of cryptococcal meningitis and all-cause mortality in advanced HIV infection.
  
  
  METHODS
  This was a systematic review and meta-analysis of randomized trials and observational studies. Google Scholar™, PubMed and Embase databases were searched for relevant studies. Quality was assessed using different criteria, depending on study type. Publication bias was assessed and subgroup and sensitivity analyses were performed. When the results of the meta-analysis were homogeneous, the fixed-effects model was used; when the results of the meta-analysis were heterogenous, the random effects model was used.
  
  
  RESULTS
  Primary prophylaxis prevented cryptococcal meningitis but did not confer protection against overall mortality, although there was evidence of a reduction in cryptococcal-specific mortality in resource-limited settings.
  
  
  CONCLUSIONS
  Primary antifungal prophylaxis should be recommended in patients with advanced HIV infection in resource-limited settings with a high incidence of cryptococcal meningitis.
authors.affiliation: School of Public Health, University of California, Berkeley 50 University Hall, 7360 Berkeley, CA 94720, USA ; Department of Medicine Makerere University College of Health Sciences, PO Box 7072, Kampala, Uganda.
authors.forename: Richard
authors.initials: R
authors.lastname: Ssekitoleko
authors.affiliation: Department of Medicine Makerere University College of Health Sciences, PO Box 7072, Kampala, Uganda.
authors.forename: Moses R
authors.initials: MR
authors.lastname: Kamya
authors.affiliation: School of Public Health, University of California, Berkeley 50 University Hall, 7360 Berkeley, CA 94720, USA.
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Reingold
keywords: advanced HIV infection; all-cause mortality; cryptococcal meningitis; fluconazole; itraconazole; prevention of cryptococcal meningitis; primary antifungal prophylaxis; resource-limited settings