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Looking for fungi in all the right places: screening for cryptococcal disease and other AIDS-related mycoses among patients with advanced HIV disease.

Publication ,  Journal Article
Greene, G; Sriruttan, C; Le, T; Chiller, T; Govender, NP
Published in: Curr Opin HIV AIDS
March 2017

PURPOSE OF REVIEW: 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. RECENT FINDINGS: 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. SUMMARY: 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.

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Published In

Curr Opin HIV AIDS

DOI

EISSN

1746-6318

Publication Date

March 2017

Volume

12

Issue

2

Start / End Page

139 / 147

Location

United States

Related Subject Headings

  • Virology
  • Mass Screening
  • Invasive Fungal Infections
  • Humans
  • HIV Infections
  • Fungi
  • Diagnostic Tests, Routine
  • Coinfection
  • AIDS-Related Opportunistic Infections
  • 4202 Epidemiology
 

Citation

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Greene, G., Sriruttan, C., Le, T., Chiller, T., & Govender, N. P. (2017). Looking for fungi in all the right places: screening for cryptococcal disease and other AIDS-related mycoses among patients with advanced HIV disease. Curr Opin HIV AIDS, 12(2), 139–147. https://doi.org/10.1097/COH.0000000000000347
Greene, Greg, Charlotte Sriruttan, Thuy Le, Tom Chiller, and Nelesh P. Govender. “Looking for fungi in all the right places: screening for cryptococcal disease and other AIDS-related mycoses among patients with advanced HIV disease.Curr Opin HIV AIDS 12, no. 2 (March 2017): 139–47. https://doi.org/10.1097/COH.0000000000000347.
Greene, Greg, et al. “Looking for fungi in all the right places: screening for cryptococcal disease and other AIDS-related mycoses among patients with advanced HIV disease.Curr Opin HIV AIDS, vol. 12, no. 2, Mar. 2017, pp. 139–47. Pubmed, doi:10.1097/COH.0000000000000347.

Published In

Curr Opin HIV AIDS

DOI

EISSN

1746-6318

Publication Date

March 2017

Volume

12

Issue

2

Start / End Page

139 / 147

Location

United States

Related Subject Headings

  • Virology
  • Mass Screening
  • Invasive Fungal Infections
  • Humans
  • HIV Infections
  • Fungi
  • Diagnostic Tests, Routine
  • Coinfection
  • AIDS-Related Opportunistic Infections
  • 4202 Epidemiology