Cryptococcal meningitis after ART: Need for proper baseline evaluation in the era of ‘Test & Treat’

Iorhen E. Akase; Olamide Olowoyo; Rita O. Oladele; Reginald O. Obiako; Adilia Warris; Sulaimon A. Akanmu

doi:10.1016/j.mmcr.2019.04.003

Cryptococcal meningitis after ART: Need for proper baseline evaluation in the era of ‘Test & Treat’

Iorhen E. Akase^* (Corresponding Author), Olamide Olowoyo, Rita O. Oladele, Reginald O. Obiako, Adilia Warris, Sulaimon A. Akanmu

^*Corresponding author for this work

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Abstract

Cryptococcal meningitis (CM) contributes significantly to high early mortality in the setting of advanced HIV. In resource poor settings, the current HIV disease management approach is focused on commencing antiretroviral therapy (ART) on the same day of HIV diagnosis (‘Test and Treat’). The HIV program in Nigeria does not currently provide CrAg screening for patients with newly diagnosed and advanced HIV disease. We report a case of severe cryptococcal meningitis presenting following the commencement of ART. There is clear benefit in the early commencement of ART among HIV infected patients and to prevent patients lost to follow-up as aimed with the ‘Test & Treat’ approach. However, this approach needs to be balanced against the risk of IRIS and its associated morbidity and mortality when those patients are not being properly evaluated for opportunistic infections being present without overt symptoms.

Original language	English
Pages (from-to)	58-60
Number of pages	3
Journal	Medical mycology case reports
Volume	24
Early online date	16 Apr 2019
DOIs	https://doi.org/10.1016/j.mmcr.2019.04.003
Publication status	Published - Jun 2019

Keywords

Cryptococcal meningitis
HIV
IRIS
Nigeria
Test and Treat

ASJC Scopus subject areas

Microbiology
Infectious Diseases

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10.1016/j.mmcr.2019.04.003Licence: CC BY-NC-ND

Cryptococcal meningitis after ART
© 2019 The Authors. Published by Elsevier B.V. on behalf of International Society for Human and Animal Mycology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/BY-NC-ND/4.0/)
Final published version, 428 KBLicence: CC BY-NC-ND

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Akase, I. E., Olowoyo, O., Oladele, R. O., Obiako, R. O., Warris, A., & Akanmu, S. A. (2019). Cryptococcal meningitis after ART: Need for proper baseline evaluation in the era of ‘Test & Treat’. Medical mycology case reports, 24, 58-60. https://doi.org/10.1016/j.mmcr.2019.04.003

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abstract = "Cryptococcal meningitis (CM) contributes significantly to high early mortality in the setting of advanced HIV. In resource poor settings, the current HIV disease management approach is focused on commencing antiretroviral therapy (ART) on the same day of HIV diagnosis ({\textquoteleft}Test and Treat{\textquoteright}). The HIV program in Nigeria does not currently provide CrAg screening for patients with newly diagnosed and advanced HIV disease. We report a case of severe cryptococcal meningitis presenting following the commencement of ART. There is clear benefit in the early commencement of ART among HIV infected patients and to prevent patients lost to follow-up as aimed with the {\textquoteleft}Test & Treat{\textquoteright} approach. However, this approach needs to be balanced against the risk of IRIS and its associated morbidity and mortality when those patients are not being properly evaluated for opportunistic infections being present without overt symptoms.",

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