Cryptococcal meningitis after ART: Need for proper baseline evaluation in the era of 'Test & Treat'.
Cryptococcal meningitis after ART: Need for proper baseline evaluation in the era of 'Test & Treat'.
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ART 后的隐球菌性脑膜炎：在“测试”时代需要进行适当的基线评估
DOI：
10.1016/j.mmcr.2019.04.003
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发表时间：
2019
影响因子：
2.2
通讯作者：
Akase IE
中科院分区：
文献类型：
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作者：
Akase IE
隐球菌性脑膜炎(CM)是晚期HIV患者早期高死亡率的重要原因。在资源匮乏的情况下，目前的艾滋病毒疾病管理办法侧重于在艾滋病毒诊断(“检测和治疗”)的同一天开始抗逆转录病毒治疗(ART)。尼日利亚的艾滋病毒方案目前没有为新诊断和晚期艾滋病毒疾病的患者提供CRAG筛查。我们报告一例严重的隐球菌性脑膜炎在ART开始后出现。在HIV感染患者中及早开始抗逆转录病毒治疗有明显的好处，并防止患者失去‘检测和治疗’方法所旨在的随访。然而，这种方法需要与IRIS的风险及其相关的发病率和死亡率进行平衡，因为这些患者没有得到适当的评估，以确定是否存在无明显症状的机会性感染。
Cryptococcal meningitis (CM) contributes significantly to high early mortality in the setting of advanced HIV. In resource poor settings, the current HIV disease management approach is focused on commencing antiretroviral therapy (ART) on the same day of HIV diagnosis (‘Test and Treat’). The HIV program in Nigeria does not currently provide CrAg screening for patients with newly diagnosed and advanced HIV disease. We report a case of severe cryptococcal meningitis presenting following the commencement of ART. There is clear benefit in the early commencement of ART among HIV infected patients and to prevent patients lost to follow-up as aimed with the ‘Test & Treat’ approach. However, this approach needs to be balanced against the risk of IRIS and its associated morbidity and mortality when those patients are not being properly evaluated for opportunistic infections being present without overt symptoms.