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A short course of fluconazole reduces mortality in HIV patients with asymptomatic CrAg

December 02 2015

In sub-Saharan Africa the detection of asymptomatic cryptococcal antigen at the time antiretroviral therapy is commenced, indicates a >20%  increased mortality in outcome.

Guidelines for treating this condition are not well established and often not even feasible where resources are low.  In Tanzania a programme to screen for cryptococcal antigen (CrAg) with implementation of a 4 week course of fluconazole for CrAg-positive patients has been tested. In a retrospective study (Kapoor et al, 2015) 6 month outcomes of  HIV-infected adults who had CD4+ cell counts less than 200 cells/ml at the time of starting ART who  had been screened for cryptococcal antigenemia were evaluated.

 For each CrAg  positive patient, three randomly selected CrAg  negative  patients were evaluated, looking at 6 month mortality as a primary outcome in both groups. The data showed that mortality of CrAg positive HIV infected adults who received a 4 week course of fluconazole, was not inferior to CrAg negative adults. Any deaths on the CrAg positive group were not attributed to cryptococcal meningits.

 The study in Tanzania indicates that the implementation of a short course of fluconazole could signicantly reduce mortality for patients who have asymptomatic cryptococcal antigenemia.

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