Cryptococcal Antigenemia in Advanced Human Immunodeficiency Virus Disease: Pathophysiology, Epidemiology, and Clinical Implications.

Autor:	Wake RM; Institute for Infection and Immunity, St George's University of London, London, United Kingdom.; Clinical Academic Group in Infection and Immunity, St George's University Hospitals National Health Service Foundation Trust, London, United Kingdom., Molloy SF; Institute for Infection and Immunity, St George's University of London, London, United Kingdom.; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa., Jarvis JN; Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana., Harrison TS; Institute for Infection and Immunity, St George's University of London, London, United Kingdom.; Clinical Academic Group in Infection and Immunity, St George's University Hospitals National Health Service Foundation Trust, London, United Kingdom.; MRC Centre for Medical Mycology, University of Exeter, Exeter, United Kingdom., Govender NP; Institute for Infection and Immunity, St George's University of London, London, United Kingdom.; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.; MRC Centre for Medical Mycology, University of Exeter, Exeter, United Kingdom.; Division of the National Health Laboratory Service, Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, Johannesburg, South Africa.; Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2023 Feb 18; Vol. 76 (4), pp. 764-770.
DOI:	10.1093/cid/ciac675
Abstrakt:	Cryptococcal antigen (CrAg) is detectable in blood prior to the onset of symptomatic cryptococcal meningitis (CM), a leading cause of death among people with advanced human immunodeficiency virus (HIV) disease globally. Highly sensitive assays can detect CrAg in blood, and screening people with HIV with low CD4 counts, followed by preemptive antifungal treatment, is recommended and widely implemented as part of a global strategy to prevent CM and end cryptococcal-related deaths. Cryptococcal antigenemia encompasses a spectrum of conditions from preclinical asymptomatic infection (cerebrospinal fluid [CSF] CrAg-negative) through subclinical (CSF CrAg-positive without overt meningism) to clinical symptomatic cryptococcal disease, usually manifesting as CM. In this review, we summarize current understanding of the pathophysiology, risk factors for, and clinical implications of cryptococcal antigenemia within this spectrum. We also provide an update on global prevalence, recommended screening and treatment strategies, and future considerations for improving outcomes among patients with cryptococcal antigenemia. Competing Interests: Potential conflicts of interest. J. J. reports grants or contracts from European and Developing Countries Clinical Trials (EDCTP) and Center for Disease Control (CDC) (paid to institution) and speaker fees from Gilead Sciences, Inc, and reports serving as chair of a data and safety monitoring board (DSMB) for the ARTIST trial, Harvest trial, and CASTLE trial. T. H. reports speaker fees from Gilead Sciences, Inc and Pfizer and reports grants or contracts from Medical Research Council (MRC), Wellcome Trust (WT), Department for International Development (DFID) Global Health Trials, and EFFECT Trial (paid to institution). N. G. reports grants from National Institute for Health and Care Research (NIHR), CDC, National Institutes of Health (NIH), Gates Foundation, and National Health Laboratory Service (NHLS) Research Trust (paid to institution) and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from SA HIV Clinicians Society (paid to author); reports servings as a DSMB member for the ACACIA trial, an advisory board member for 5FC-Crypto, and an advisory board chair for DREAMM; is the president and council member for Federation of Infectious Diseases Societies of Southern Africa (FIDSSA), a member of the CryptoMAG, Ambassador for GAFFI, a board member for the Medical Mycology Society Nigeria, and a member for LIGHT Africa; and includes receipt of equipment, materials, drugs, medical writing, gifts, or other services from Immy CrAg tests and OIDx Histoplasma antigen tests (paid to institution). All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. (© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
Databáze:	MEDLINE
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