Asymptomatic Cryptococcemia in Resource-Limited Settings. Despite increasing availability of anti-retroviral therapy, invasive cryptococcal disease continues to be a leading cause of death among HIV-infected individuals in resource-limited settings. Screening asymptomatic HIV-infected individuals with advanced immunosuppression for serum cryptococcal antigen clearly identifies a population at high risk of cryptococcal meningitis and death. Screening with serum cryptococcal antigen alone identifies many whom have mild clinical symptoms, sub-clinical meningeal infection, or fungemia. There is wide variation in practice and little evidence to guide the use of anti-fungal and anti-retroviral treatment for asymptomatic cryptococcal antigenemia (ACA). Implementing a targeted screening and treatment intervention for ACA presents challenges for an overburdened health care systems in resource-limited settings. While such an intervention shows promise, there are critical gaps in our understanding of ACA and its implications in the outpatient setting.
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