Strategies to reduce mortality and morbidity due to AIDS-related cryptococcal meningitis in Latin America

Strategies to reduce mortality and morbidity due to AIDS-related cryptococcal meningitis in Latin America

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Latin America is the region with the third most AIDS-related cryptococcal meningitis infections globally. Highly active antiretroviral therapy (HAART) has reduced the number of infections; however, the number of deaths and the case-fatality rate continues to be unacceptable. In this review, we focus...

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Bibliographic Details
Main Authors: Jose E. Vidal, Augusto C. Penalva de Oliveira, Rafi F. Dauar, David R. Boulware
Format: Article
Language:English
Published: Elsevier 2013-06-01
Series:Brazilian Journal of Infectious Diseases
Subjects:
Cryptococcal meningitis
Cryptococccosis
Epidemiology
Diagnosis
Treatment
Mortality
Latin America
Online Access:http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702013000300008
Description
Summary:Latin America is the region with the third most AIDS-related cryptococcal meningitis infections globally. Highly active antiretroviral therapy (HAART) has reduced the number of infections; however, the number of deaths and the case-fatality rate continues to be unacceptable. In this review, we focus on the burden of AIDS-related cryptococcosis in Latin America and discuss potential strategies to reduce early mortality from Cryptococcus. In this review, we highlight the importance of: (1) earlier HIV diagnosis and HAART initiation with retention-in-care to avoid AIDS; (2) pre-HAART cryptococcal antigen (CRAG) screening with preemptive fluconazole treatment; (3) better diagnostics (e.g. CRAG testing); and (4) optimal treatment with aggressive management of intracranial pressure and induction therapy with antifungal combination. Implementation of these strategies can reduce cryptococcal-related deaths, improve care, and reduce healthcare costs.
ISSN:1413-8670
1678-4391

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