Global burden of disease of HIV-associated cryptococcal meningitis: an updated analysis.
Global burden of disease of HIV-associated cryptococcal meningitis: an updated analysis.
复制标题
DOI：
10.1016/s1473-3099(17)30243-8
复制
发表时间：
2017-08
期刊：
影响因子：
--
通讯作者：
Boulware DR
中科院分区：
文献类型：
--
作者：
Rajasingham R;Smith RM;Park BJ;Jarvis JN;Govender NP;Chiller TM;Denning DW;Loyse A;Boulware DR
隐球菌是撒哈拉以南非洲成年艾滋病毒感染者脑膜炎的最常见原因。全球负担估计对于指导预防战略和确定治疗需求至关重要，我们的目标是提供有关艾滋病毒相关隐球菌病全球发病率的最新估计。我们使用了2014年联合国艾滋病毒和艾滋病联合规划署对艾滋病毒和抗逆转录病毒治疗（ART）覆盖率的成年人（0 - 15岁）的估计。CD4小于100个细胞/µL、病毒学失败发生率和随访损失的估计值来自已发表的低收入和中等收入国家的多国队列。我们计算了那些有隐球菌感染风险的人，特别是那些CD4低于100细胞/µL而未接受抗逆转录病毒治疗的人，以及那些CD4低于100细胞/µL而接受抗逆转录病毒治疗但随访失败或病毒学失败的人。按国家分列的隐球菌抗原血症流行率来自全球46项研究。根据每个国家和地区隐球菌抗原血症的流行情况，我们估计了每年因隐球菌性脑膜炎而发病和死亡的人数。我们估计，在CD4细胞计数低于每µL 100个细胞的人群中，全球隐球菌抗原血症的平均患病率为6.0% (95% CI为5.8 - 6.2)，2014年全球隐球菌抗原阳性人数为27.8万（95% CI为195 500-340 600），隐球菌脑膜炎病例为223 100 （95% CI为150 600 - 282 400）。2014年，撒哈拉以南非洲地区占隐球菌脑膜炎估计病例的73%（162 500例[95%可信区间113 600-193 900]）。全球每年死于隐球菌脑膜炎的人数估计为181 100人（95%可信区间为119 400-234 300），其中撒哈拉以南非洲死亡人数为135 900人（75%；[95%可信区间为93 900 - 163 900]）。在全球范围内，隐球菌脑膜炎导致15%的艾滋病相关死亡（95% CI 10-19）。我们的分析强调了与艾滋病毒相关的隐球菌疾病的巨大持续负担，主要是在撒哈拉以南非洲。隐球菌性脑膜炎是衡量艾滋病毒治疗方案失败的指标；及时的艾滋病毒检测和迅速与护理联系仍然是一个紧迫的优先事项。没有。
Cryptococcus is the most common cause of meningitis in adults living with HIV in sub-Saharan Africa. Global burden estimates are crucial to guide prevention strategies and to determine treatment needs, and we aimed to provide an updated estimate of global incidence of HIV-associated cryptococcal disease. We used 2014 Joint UN Programme on HIV and AIDS estimates of adults (aged >15 years) with HIV and antiretroviral therapy (ART) coverage. Estimates of CD4 less than 100 cells per µL, virological failure incidence, and loss to follow-up were from published multinational cohorts in low-income and middle-income countries. We calculated those at risk for cryptococcal infection, specifically those with CD4 less than 100 cells/µL not on ART, and those with CD4 less than 100 cells per µL on ART but lost to follow-up or with virological failure. Cryptococcal antigenaemia prevalence by country was derived from 46 studies globally. Based on cryptococcal antigenaemia prevalence in each country and region, we estimated the annual numbers of people who are developing and dying from cryptococcal meningitis. We estimated an average global cryptococcal antigenaemia prevalence of 6·0% (95% CI 5·8–6·2) among people with a CD4 cell count of less than 100 cells per µL, with 278 000 (95% CI 195 500–340 600) people positive for cryptococcal antigen globally and 223 100 (95% CI 150 600–282 400) incident cases of cryptococcal meningitis globally in 2014. Sub-Saharan Africa accounted for 73% of the estimated cryptococcal meningitis cases in 2014 (162 500 cases [95% CI 113 600–193 900]). Annual global deaths from cryptococcal meningitis were estimated at 181 100 (95% CI 119 400–234 300), with 135 900 (75%; [95% CI 93 900–163 900]) deaths in sub-Saharan Africa. Globally, cryptococcal meningitis was responsible for 15% of AIDS-related deaths (95% CI 10–19). Our analysis highlights the substantial ongoing burden of HIV-associated cryptococcal disease, primarily in sub-Saharan Africa. Cryptococcal meningitis is a metric of HIV treatment programme failure; timely HIV testing and rapid linkage to care remain an urgent priority. None.