Cryptococcal Antigen Screening and Early Antifungal Treatment to Prevent Cryptococcal Meningitis: A Review of the Literature
Cryptococcal Antigen Screening and Early Antifungal Treatment to Prevent Cryptococcal Meningitis: A Review of the Literature
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DOI：
10.1097/qai.0000000000000484
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发表时间：
2015-04-15
影响因子：
3.6
通讯作者：
Park, Benjamin
中科院分区：
文献类型：
--
作者：
Kaplan, Jonathan E.;Vallabhaneni, Snigdha;Park, Benjamin
背景：对艾滋病患者进行血清隐球菌抗原(CRAG)筛查，然后对CRAG阳性患者进行抗真菌药物治疗，可以预防隐球菌性脑膜炎。方法：我们检索了2007-2014年间发表的关于CRAG筛查和治疗的有效性和成本效益的文章，这些文章涉及CRAG筛查和治疗对死亡率、发病率、留存率、生活质量和/或持续HIV传播的预防效果。我们对单个文章的整体质量进行评分，总结证据主体、预期影响和每个结果的成本效益。结果：我们确定了2613篇文章。其中8个符合所有纳入标准。5项研究涉及死亡率和/或发病率结果；所有研究都是观察性的，样本量小；3项研究没有对照组。研究质量的评级从中等到较弱，死亡率和发病率结果的整体证据质量被评为中等。干预措施对死亡率和发病率的预期影响被评为中等。分析中包含的4项成本-效果研究表明，CRAG筛查和治疗干预措施具有很高的成本效益。没有研究涉及保留护理、生活质量或艾滋病毒传播。结论：虽然有限，但有关CRAG筛查和治疗的大量证据表明，干预措施可能对预防艾滋病患者的隐球菌性脑膜炎和死亡有影响。还需要更多的研究来量化干预的有效性，并确定最佳治疗剂量和实施最佳做法。
Background:Screening individuals with AIDS for serum cryptococcal antigen (CrAg), followed by treatment of CrAg positives with antifungals, may prevent cryptococcal meningitis. This review examined data on CrAg screening and treatment in resource-limited settings.Methods:We searched articles published during 2007-2014 on the effectiveness and cost-effectiveness of CrAg screening and treatment on the outcomes of mortality, morbidity, retention in care, quality of life, and/or prevention of ongoing HIV transmission. We rated overall quality of individual articles, summarized the body of evidence, the expected impact, and cost-effectiveness for each outcome.Results:We identified 2613 articles. Eight met all inclusion criteria. Five studies addressed mortality and/or morbidity outcomes; all were observational and had small sample sizes; 3 lacked a comparison group. Ratings of study quality ranged from medium to weak, and the quality of the overall body of evidence for mortality and morbidity outcomes was rated as fair. The intervention's expected impact on mortality and morbidity was rated as moderate. The 4 cost-effectiveness studies included in the analysis showed that CrAg screening and treatment interventions are highly cost-effective. No studies addressed retention in care, quality of life, or HIV transmission.Conclusions:Although limited, the body of evidence regarding CrAg screening and treatment suggests that the intervention may have an impact on preventing cryptococcal meningitis and death in persons with AIDS. Additional research is needed to quantify the intervention's effectiveness and identify optimal treatment dosing and implementation best practices.