CD4 cell count threshold for cryptococcal antigen screening of HIV-infected individuals: a systematic review and meta-analysis. Ford, N., Shubber, Z., Jarvis, J. N, Chiller, T., Greene, G., Migone, C., Vitoria, M., Doherty, M., & Meintjes, G. A Clinical Infectious Diseases, 66(S2):S152–S159, Oxford University Press, mar, 2018. ![CD4 cell count threshold for cryptococcal antigen screening of HIV-infected individuals: a systematic review and meta-analysis [link]](https://bibbase.org/img/filetypes/link.svg "link")
Paper doi abstract bibtex Background Current guidelines recommend screening all people living with human immunodeficiency virus (PLHIV) who have a CD4 count ≤100 cells/µL for cryptococcal antigen (CrAg) to identify those patients who could benefit from preemptive fluconazole treatment prior to the onset of meningitis. We conducted a systematic review to assess the prevalence of CrAg positivity at different CD4 cell counts. Methods We searched 4 databases and abstracts from 3 conferences up to 1 September 2017 for studies reporting prevalence of CrAg positivity according to CD4 cell count strata. Prevalence estimates were pooled using random effects models. Results Sixty studies met our inclusion criteria. The pooled prevalence of cryptococcal antigenemia was 6.5% (95% confidence interval [CI], 5.7%–7.3%; 54 studies) among patients with CD4 count ≤100 cells/µL and 2.0% (95% CI, 1.2%–2.7%; 21 studies) among patients with CD4 count 101–200 cells/µL. Twenty-one studies provided sufficient information to compare CrAg prevalence per strata; overall, 18.6% (95% CI, 15.4%–22.2%) of the CrAg-positive cases identified at ≤200 cells/µL (n = 11823) were identified among individuals with a CD4 count 101–200 cells/µL. CrAg prevalence was higher among inpatients (9.8% [95% CI, 4.0%–15.5%]) compared with outpatients (6.3% [95% CI, 5.3%–7.4%]). Conclusions The findings of this review support current recommendations to screen all PLHIV who have a CD4 count ≤100 cells/µL for CrAg and suggest that screening may be considered at CD4 cell count ≤200 cells/µL.
@article{Ford2018,
abstract = {Background Current guidelines recommend screening all people living with human immunodeficiency virus (PLHIV) who have a CD4 count ≤100 cells/µL for cryptococcal antigen (CrAg) to identify those patients who could benefit from preemptive fluconazole treatment prior to the onset of meningitis. We conducted a systematic review to assess the prevalence of CrAg positivity at different CD4 cell counts. Methods We searched 4 databases and abstracts from 3 conferences up to 1 September 2017 for studies reporting prevalence of CrAg positivity according to CD4 cell count strata. Prevalence estimates were pooled using random effects models. Results Sixty studies met our inclusion criteria. The pooled prevalence of cryptococcal antigenemia was 6.5{\%} (95{\%} confidence interval [CI], 5.7{\%}–7.3{\%}; 54 studies) among patients with CD4 count ≤100 cells/µL and 2.0{\%} (95{\%} CI, 1.2{\%}–2.7{\%}; 21 studies) among patients with CD4 count 101–200 cells/µL. Twenty-one studies provided sufficient information to compare CrAg prevalence per strata; overall, 18.6{\%} (95{\%} CI, 15.4{\%}–22.2{\%}) of the CrAg-positive cases identified at ≤200 cells/µL (n = 11823) were identified among individuals with a CD4 count 101–200 cells/µL. CrAg prevalence was higher among inpatients (9.8{\%} [95{\%} CI, 4.0{\%}–15.5{\%}]) compared with outpatients (6.3{\%} [95{\%} CI, 5.3{\%}–7.4{\%}]). Conclusions The findings of this review support current recommendations to screen all PLHIV who have a CD4 count ≤100 cells/µL for CrAg and suggest that screening may be considered at CD4 cell count ≤200 cells/µL.},
author = {Ford, Nathan and Shubber, Zara and Jarvis, Joseph N and Chiller, Tom and Greene, Greg and Migone, Chantal and Vitoria, Marco and Doherty, Meg and Meintjes, Graeme A},
doi = {10.1093/cid/cix1143},
file = {:C$\backslash$:/Users/01462563/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Ford et al. - 2018 - CD4 cell count threshold for cryptococcal antigen screening of HIV-infected individuals a systematic review and met.pdf:pdf},
journal = {Clinical Infectious Diseases},
keywords = {CrAg,HIV,OA,advanced HIV disease,cryptococcal antigen,cryptococcal meningitis,fund{\_}not{\_}ack,original},
mendeley-tags = {OA,fund{\_}not{\_}ack,original},
month = {mar},
number = {S2},
pages = {S152--S159},
pmid = {29514236},
publisher = {Oxford University Press},
title = {{CD4 cell count threshold for cryptococcal antigen screening of HIV-infected individuals: a systematic review and meta-analysis}},
url = {https://academic.oup.com/cid/article/66/suppl{\_}2/S152/4918992},
volume = {66},
year = {2018}
}
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Prevalence estimates were pooled using random effects models. Results Sixty studies met our inclusion criteria. The pooled prevalence of cryptococcal antigenemia was 6.5% (95% confidence interval [CI], 5.7%–7.3%; 54 studies) among patients with CD4 count ≤100 cells/µL and 2.0% (95% CI, 1.2%–2.7%; 21 studies) among patients with CD4 count 101–200 cells/µL. Twenty-one studies provided sufficient information to compare CrAg prevalence per strata; overall, 18.6% (95% CI, 15.4%–22.2%) of the CrAg-positive cases identified at ≤200 cells/µL (n = 11823) were identified among individuals with a CD4 count 101–200 cells/µL. CrAg prevalence was higher among inpatients (9.8% [95% CI, 4.0%–15.5%]) compared with outpatients (6.3% [95% CI, 5.3%–7.4%]). Conclusions The findings of this review support current recommendations to screen all PLHIV who have a CD4 count ≤100 cells/µL for CrAg and suggest that screening may be considered at CD4 cell count ≤200 cells/µL.","author":[{"propositions":[],"lastnames":["Ford"],"firstnames":["Nathan"],"suffixes":[]},{"propositions":[],"lastnames":["Shubber"],"firstnames":["Zara"],"suffixes":[]},{"propositions":[],"lastnames":["Jarvis"],"firstnames":["Joseph","N"],"suffixes":[]},{"propositions":[],"lastnames":["Chiller"],"firstnames":["Tom"],"suffixes":[]},{"propositions":[],"lastnames":["Greene"],"firstnames":["Greg"],"suffixes":[]},{"propositions":[],"lastnames":["Migone"],"firstnames":["Chantal"],"suffixes":[]},{"propositions":[],"lastnames":["Vitoria"],"firstnames":["Marco"],"suffixes":[]},{"propositions":[],"lastnames":["Doherty"],"firstnames":["Meg"],"suffixes":[]},{"propositions":[],"lastnames":["Meintjes"],"firstnames":["Graeme","A"],"suffixes":[]}],"doi":"10.1093/cid/cix1143","file":":C$\\$:/Users/01462563/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Ford et al. - 2018 - CD4 cell count threshold for cryptococcal antigen screening of HIV-infected individuals a systematic review and met.pdf:pdf","journal":"Clinical Infectious Diseases","keywords":"CrAg,HIV,OA,advanced HIV disease,cryptococcal antigen,cryptococcal meningitis,fund_not_ack,original","mendeley-tags":"OA,fund_not_ack,original","month":"mar","number":"S2","pages":"S152–S159","pmid":"29514236","publisher":"Oxford University Press","title":"CD4 cell count threshold for cryptococcal antigen screening of HIV-infected individuals: a systematic review and meta-analysis","url":"https://academic.oup.com/cid/article/66/suppl\\_2/S152/4918992","volume":"66","year":"2018","bibtex":"@article{Ford2018,\r\nabstract = {Background Current guidelines recommend screening all people living with human immunodeficiency virus (PLHIV) who have a CD4 count ≤100 cells/µL for cryptococcal antigen (CrAg) to identify those patients who could benefit from preemptive fluconazole treatment prior to the onset of meningitis. We conducted a systematic review to assess the prevalence of CrAg positivity at different CD4 cell counts. Methods We searched 4 databases and abstracts from 3 conferences up to 1 September 2017 for studies reporting prevalence of CrAg positivity according to CD4 cell count strata. Prevalence estimates were pooled using random effects models. Results Sixty studies met our inclusion criteria. The pooled prevalence of cryptococcal antigenemia was 6.5{\\%} (95{\\%} confidence interval [CI], 5.7{\\%}–7.3{\\%}; 54 studies) among patients with CD4 count ≤100 cells/µL and 2.0{\\%} (95{\\%} CI, 1.2{\\%}–2.7{\\%}; 21 studies) among patients with CD4 count 101–200 cells/µL. Twenty-one studies provided sufficient information to compare CrAg prevalence per strata; overall, 18.6{\\%} (95{\\%} CI, 15.4{\\%}–22.2{\\%}) of the CrAg-positive cases identified at ≤200 cells/µL (n = 11823) were identified among individuals with a CD4 count 101–200 cells/µL. 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