title: Evaluation of screening and treatment of cryptococcal antigenaemia among HIV-infected persons in Soweto, South Africa.
abstract: OBJECTIVE
  We retrospectively evaluated clinic-based screening to determine the prevalence of cryptococcal antigenaemia and management and outcome of patients with antigenaemia.
  
  
  METHODS
  Cryptococcal antigen (CrAg) screening of HIV-infected adults who attended the HIV clinic at Chris Hani Baragwanath Hospital was conducted over 19 months. Data collected from CrAg-positive patients included CD4 T-lymphocyte count at screening, prior or subsequent cryptococcal meningitis (CM), antifungal and antiretroviral treatment and outcome after at least 8 months.
  
  
  RESULTS
  Of 1460 patients with no prior CM, 30 (2.1%) had a positive CrAg test. The prevalence of antigenaemia among patients with a CD4 count < 100 cells/μl and no prior CM was 2.8% (20 of 708). Of 29 evaluable CrAg-positive patients with no prior CM, 14 (48%) did not return for post-screening follow-up. Of these 14, five developed CM and one (7%) was known to be alive at follow-up. Of 15 patients who returned for follow-up, two already had evidence of nonmeningeal cryptococcosis. Overall, 11 received fluconazole, one did not and fluconazole treatment was unknown for three. Among these 15, one developed CM and 10 (67%) were known to be alive at follow-up. Overall, 18 (62%) of 29 CrAg-positive patients died or were lost to follow-up. Seven (0.5%) of 1430 CrAg-negative patients developed CM a median of 83 days post-screening (range 34 to 219 days).
  
  
  CONCLUSIONS
  Loss to follow-up is the major operational issue relevant to scale-up of screen-and-treat. Patient outcomes may be improved by rapid access to CrAg results and focus on linkage to and retention in HIV care.
authors.affiliation: National Institute for Communicable Diseases (Centre for Opportunistic, Tropical and Hospital Infections), a Division of the National Health Laboratory Service, Johannesburg, South Africa.|Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: N P
authors.initials: NP
authors.lastname: Govender
authors.affiliation: Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Roy
authors.affiliation: Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.|Department of Community Health, Gauteng Department of Health, Johannesburg, South Africa.
authors.forename: J F
authors.initials: JF
authors.lastname: Mendes
authors.affiliation: National Institute for Communicable Diseases (Centre for Opportunistic, Tropical and Hospital Infections), a Division of the National Health Laboratory Service, Johannesburg, South Africa.
authors.forename: T G
authors.initials: TG
authors.lastname: Zulu
authors.affiliation: Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: T M
authors.initials: TM
authors.lastname: Chiller
authors.affiliation: Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.|Division of Infectious Diseases, Department of Medicine, Chris Hani Baragwanath Hospital, Soweto, South Africa.
authors.forename: A S
authors.initials: AS
authors.lastname: Karstaedt
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D000946:Antigens, Fungal / Q000032:analysis / Q000097:blood; D018791:CD4 Lymphocyte Count; D003455:Cryptococcus neoformans / Q000276:immunology / Q000302:isolation & purification; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D016919:Meningitis, Cryptococcal / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology
chemical_list: D000935:Antifungal Agents; D000946:Antigens, Fungal
keywords: South Africa; cryptococcal antigen; cryptococcal meningitis; evaluation; screen-and-treat