New data suggest that the prevalence of cryptococcal meningitis among individuals with AIDS in the United States is high and routine screening for cryptococcal antigen in these patients would be cost effective.
“Compared with other biomedical interventions in HIV/AIDS care such as HIV antiretroviral treatment and substance use treatment programs, screening for cryptococcal infection may be more cost effective,” the researchers wrote in Clinical Infectious Diseases. “In a cost-effective analysis … in which different HIV/AIDS interventions were analyzed, the individual costs for cryptococcal screening were significantly lower than the cost of antiretroviral therapy per person, estimated to be $20,000, and cryptococcal screening was to be more beneficial.”
Researchers from the University of California, Los Angeles evaluated stored serum specimens from patients enrolled in the Multicenter AIDS Cohort Study and the Women’s Interagency HIV Study from 1982 to 2012. All of the participants had a CD4 count of less than 100 cells/mcL. The researchers screened 1,872 serum samples for the cryptococccal antigen.
Fifty-five of the samples (2.9%) were positive for cryptococcal antigen and 10 of them were from patients with a prior history of cryptococcal meningitis. The rate of cryptococcal antigen positivity among individuals with no history of cryptococcal meningitis was 2.5%. There were no significant differences by age, gender, study location, race and education and cryptococcal antigen test result, but a previous diagnosis of cryptococcal meningitis and a low CD4 count were associated with cryptococcal antigen positivity.
The researchers analyzed time from specimen collection to death among participants without a history of cryptococcal meningitis. They found a significant difference in survival between patients with positive and negative cryptococcal antigen specimens. Those with a positive result lived an average of 2.8 years after the specimen was collected, compared with 3.8 years for those with a negative result.
“The results from our study suggest the prevalence of cryptococcal infection among advanced AIDS patients in the United States is substantial, clinically important, and above the published cost-effectiveness threshold for routine screening and treatment in those with CD4 count less than 100 cells/mcL,” the researchers wrote. “Current screening recommendations warrant revision.”
Disclosure: The researchers report no relevant financial disclosures.