title: Looking for fungi in all the right places: screening for cryptococcal disease and other AIDS-related mycoses among patients with advanced HIV disease.
abstract: As HIV treatment programmes scale up to meet the UNAIDS 90-90-90 goals, care must be taken to start antiretroviral treatment safely in patients with advanced disease (CD4 counts <200 cells/μl) who are simultaneously at risk for opportunistic infections and immune reconstitution inflammatory syndrome. Invasive fungal diseases pose a great threat at this critical time point, though the development of inexpensive and highly accurate rapid diagnostic tests has changed the approach HIV programmes are taking to reduce the high mortality associated with these opportunistic infections. This article summarizes recent advances and findings in fungal opportunistic infection diagnostics with a focus on screening to prevent cryptococcal meningitis.
  
  
  
  Cryptococcal antigen (CrAg) screening using a lateral flow assay platform is cost-effective and feasible to implement as either a laboratory reflex or point-of-care test. Recent CrAg screening pilots have elucidated the varying prevalence of cryptococcal antigenemia across geographic regions, which may aid programme planning. Evidence from recently completed clinical trials provides a strong motivation for the use of CrAg titer to refine treatment options for patients with subclinical cryptococcal disease.
  
  
  
  Although several operational barriers to programme effectiveness still need to be addressed, the utility of CrAg screening using inexpensive and accurate antigen assays has been demonstrated in real-world HIV programmes, paving the way for development and testing of other fungal opportunistic infection screening strategies and for an integrated advanced HIV disease testing package to reduce AIDS mortality and ensure safe antiretroviral treatment initiation.
authors.affiliation: aMycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA bNational Institute for Communicable Diseases - Centre for Opportunistic, Tropical and Hospital Infections cClinical Microbiology and Infectious Diseases Department, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa dOxford University Clinical Research Unit, Ho Chi Minh City, Vietnam eCentre for Tropical Medicine and Global Health, Oxford University, Oxford, UK fHawaii Center for AIDS, University of Hawaii at Manoa, Honolulu, Hawaii, USA gDivision of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
authors.forename: Greg
authors.initials: G
authors.lastname: Greene
authors.forename: Charlotte
authors.initials: C
authors.lastname: Sriruttan
authors.forename: Thuy
authors.initials: T
authors.lastname: Le
authors.forename: Tom
authors.initials: T
authors.lastname: Chiller
authors.forename: Nelesh P
authors.initials: NP
authors.lastname: Govender
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis*; D060085:Coinfection / Q000175:diagnosis*; D003955:Diagnostic Tests, Routine / Q000379:methods* / Q000639:trends; D005658:Fungi / Q000187:drug effects / Q000302:isolation & purification*; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D000072742:Invasive Fungal Infections / Q000175:diagnosis* / Q000517:prevention & control; D008403:Mass Screening / Q000379:methods / Q000639:trends