title: Cryptococcal antigen screening and early antifungal treatment to prevent cryptococcal meningitis: a review of the literature.
abstract: BACKGROUND
  Screening individuals with AIDS for serum cryptococcal antigen (CrAg), followed by treatment of CrAg positives with antifungals, may prevent cryptococcal meningitis. This review examined data on CrAg screening and treatment in resource-limited settings.
  
  
  METHODS
  We searched articles published during 2007-2014 on the effectiveness and cost-effectiveness of CrAg screening and treatment on the outcomes of mortality, morbidity, retention in care, quality of life, and/or prevention of ongoing HIV transmission. We rated overall quality of individual articles, summarized the body of evidence, the expected impact, and cost-effectiveness for each outcome.
  
  
  RESULTS
  We identified 2613 articles. Eight met all inclusion criteria. Five studies addressed mortality and/or morbidity outcomes; all were observational and had small sample sizes; 3 lacked a comparison group. Ratings of study quality ranged from "medium" to "weak," and the quality of the overall body of evidence for mortality and morbidity outcomes was rated as "fair." The intervention's expected impact on mortality and morbidity was rated as "moderate." The 4 cost-effectiveness studies included in the analysis showed that CrAg screening and treatment interventions are highly cost-effective. No studies addressed retention in care, quality of life, or HIV transmission.
  
  
  CONCLUSIONS
  Although limited, the body of evidence regarding CrAg screening and treatment suggests that the intervention may have an impact on preventing cryptococcal meningitis and death in persons with AIDS. Additional research is needed to quantify the intervention's effectiveness and identify optimal treatment dosing and implementation best practices.
authors.affiliation: *HIV Care and Treatment Branch, Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, GA; and †Mycotic Diseases Branch, Division of Foodborne-Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Kaplan
authors.forename: Snigdha
authors.initials: S
authors.lastname: Vallabhaneni
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Smith
authors.forename: Sekai
authors.initials: S
authors.lastname: Chideya-Chihota
authors.forename: Joel
authors.initials: J
authors.lastname: Chehab
authors.forename: Benjamin
authors.initials: B
authors.lastname: Park
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D000946:Antigens, Fungal / Q000276:immunology*; D003362:Cost-Benefit Analysis; D003455:Cryptococcus neoformans / Q000276:immunology* / Q000302:isolation & purification; D003906:Developing Countries; D042241:Early Diagnosis; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D062489:Health Impact Assessment; D006295:Health Resources; D006801:Humans; D008403:Mass Screening; D016919:Meningitis, Cryptococcal / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D009017:Morbidity; D017063:Outcome Assessment, Health Care; D011788:Quality of Life
chemical_list: D000935:Antifungal Agents; D000946:Antigens, Fungal