Rapid advice: diagnosis, prevention and management of cryptococcal disease in HIV-infected adults, adolescents and children

    Año de publicación: 2011

    Increasing access to antiretroviral therapy (ART) has transformed the prognosis of HIVinfected patients in resource-limited settings (RLS). However, treatment coverage remains relatively low, and HIV diagnosis occurs at a late stage. As a result, many patients continue to die of HIV-related opportunistic infections (OIs) in the weeks prior to, and months following initiation of ART. Cryptococcal disease is one of the most important OIs, and a major contributor to this early mortality, accounting for between 13% and 44% of deaths in HIV-infected cohorts in resource-limited countries. In subSaharan Africa alone, there are more than 500,000 deaths each year due to cryptococcal meningitis (CM), which may exceed those attributed to tuberculosis. This guideline will provide recommendations on the prevention, diagnosis and management of cryptococcal disease in HIV-infected adults, adolescents (10-19 years) and children (up to 10 years), with a focus on settings with limited health systems capacity and resources, and a high burden of cryptococcal disease, to outline standards for high quality care of persons living with HIV infection (PLHIV) and patients with cryptococcal disease, by providing evidence-based recommendations that consider the risks and benefits, acceptability, feasibility, cost and other resource implications and to identify gaps and prioritize areas where further clinical and operational research are required.

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