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

• 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

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.