Last data update: May 13, 2024. (Total: 46773 publications since 2009)
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Query Trace: Oladoyinbo S[original query] |
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Preventing AIDS deaths: cryptococcal antigen screening and treatment
Klausner JD , Govender N , Oladoyinbo S , Roy M , Chiller T . Lancet Infect Dis 2012 12 (6) 431-2 We applaud the study by Rosalind Parkes-Ratanshi and colleagues,1 which showed the development of cryptococcal disease among patients with HIV/AIDS who were initially cryptococcal antigen (CrAg) negative, and the benefit of primary fluconazole prophylaxis in this population. Our group and others in South Africa have supported efforts to increase screening and treatment of severely immunocompromised HIV-infected people for CrAg by reflexive testing with a new rapid and simple US Food and Drug Administration cleared lateral flow assay (LFA) among patients with a CD4 count of less than 100 cells per μL.2, 3 In our opinion, the additional benefit of prophylaxis in those who screen CrAg negative might not be cost effective, given the large number of patients who will need to be prophylactically treated. We encourage public-health officials to consider that a CrAg screening and treatment programme alone, without an additional prophylaxis component, might be sufficient to substantially reduce cryptococcal-related morbidity and mortality. | In the study by Parkes-Ratanshi and colleagues,1 18 of 759 patients in the placebo group compared with one of 760 in the treatment group developed cryptococcal disease a mean of 7 weeks after testing CrAg negative; most were awaiting antiretroviral therapy. We suggest two actions to reduce this somewhat high incidence before adding a prophylaxis programme to already-strained public-health systems. |
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