| Summary: | The case fatality rate in patients with cryptococcal meningitis, the commonest presentation of HIV-related cryptococcal disease in adults, remains unacceptably high, particularly in sub-Saharan Africa. The main reason for this is a delay in presentation with diagnosis only when meningitis is advanced and treatment is less effective, mainly as a result of limited access to lumbar puncture (LP) and rapid diagnostic assays. A further contributing factor is the poor availability and high cost of the first-line anti-fungal induction treatment -- intravenous amphotericin B, and the ability to monitor and manage its treatment-limiting toxicities, as well as the frequent complication of raised intracranial pressure. The publication provides both a summary of the key evidence and its assessment using the GRADE process, and 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. It outlines standards for high quality care of persons living with HIV infection and patients with cryptococcal disease, by providing evidence-based recommendations that consider the risks and benefits, acceptability, feasibility, cost and other resource implications. Target audience: The recommendations are aimed at policy makers, national treatment advisory boards, and HIV programme managers, as well as health-care professionals providing care for HIV-infected adults, adolescents, and children in both outpatient and inpatient settings
|
|---|