{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T23:29:43Z","timestamp":1779233383339,"version":"3.51.4"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2019,11,3]],"date-time":"2019-11-03T00:00:00Z","timestamp":1572739200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["D43TW009345"],"award-info":[{"award-number":["D43TW009345"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K01TW010268"],"award-info":[{"award-number":["K01TW010268"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["K23AI138851"],"award-info":[{"award-number":["K23AI138851"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["U01AI125003"],"award-info":[{"award-number":["U01AI125003"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["DEL-15-011"],"award-info":[{"award-number":["DEL-15-011"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["107742\/Z\/15\/Z"],"award-info":[{"award-number":["107742\/Z\/15\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,10,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Detectable serum or plasma cryptococcal antigen (CrAg) precedes symptomatic cryptococcal meningitis. The World Health Organization recommends CrAg screening for human immunodeficiency virus\u2013positive persons with CD4 count &amp;lt;100 cells\/\u03bcL initiating antiretroviral therapy (ART). However, an increasing proportion of patients with cryptococcosis are now ART experienced. Whether CrAg screening is cost-effective in those with virologic failure is unknown.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We retrospectively performed nationwide plasma CrAg testing among ART-experienced Ugandan adults with virologic failure (\u22651000 copies\/mL) using leftover plasma after viral load testing during September 2017\u2013January 2018. For those who were CrAg positive, we obtained ART history, meningitis occurrence, and 6-month survival via medical records review.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 1186 subjects with virologic failure, 35 (3.0%) were CrAg positive with median ART duration of 41 months (interquartile range, 10\u201384 months). Among 25 subjects with 6-month outcomes, 16 (64%) survived, 7 (28%) died, and 2 (8%) were lost. One survivor had suffered cryptococcal meningitis 2 years prior. Two others developed cryptococcal meningitis and survived. Five survivors were known to have received fluconazole. Thus, meningitis-free survival at 6 months was 61% (14\/23). Overall, 91% (32\/35) of CrAg-positive persons had viral load \u22655000 copies\/mL compared with 64% (735\/1151) of CrAg-negative persons (odds ratio, 6.0 [95% confidence interval, 1.8\u201319.8]; P = .001). CrAg prevalence was 4.2% (32\/768) among those with viral loads \u22655000 copies\/mL and 0.7% (3\/419) among those with viral loads &amp;lt;5000 copies\/mL.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In addition to the CD4 threshold of &amp;lt;100 cells\/\u03bcL, reflexive CrAg screening should be considered in persons failing ART in Uganda with viral loads \u22655000 copies\/mL.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciz1069","type":"journal-article","created":{"date-parts":[[2019,10,28]],"date-time":"2019-10-28T12:09:07Z","timestamp":1572264547000},"page":"1726-1731","source":"Crossref","is-referenced-by-count":11,"title":["Cryptococcal Antigenemia in Human Immunodeficiency Virus Antiretroviral Therapy\u2013Experienced Ugandans With Virologic Failure"],"prefix":"10.1093","volume":"71","author":[{"given":"Edward","family":"Mpoza","sequence":"first","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Radha","family":"Rajasingham","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lillian","family":"Tugume","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua","family":"Rhein","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Sarah","family":"Nabaggala","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isaac","family":"Ssewanyana","sequence":"additional","affiliation":[{"name":"Uganda National Health Laboratory Systems, Kampala, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wilson","family":"Nyegenye","sequence":"additional","affiliation":[{"name":"Uganda National Health Laboratory Systems, Kampala, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grace Esther","family":"Kushemererwa","sequence":"additional","affiliation":[{"name":"Uganda National Health Laboratory Systems, Kampala, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vivienne","family":"Mulema","sequence":"additional","affiliation":[{"name":"Clinton Health Access Initiative, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julius","family":"Kalamya","sequence":"additional","affiliation":[{"name":"Centers for Diseases Control and Prevention - Uganda, Entebbe, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles","family":"Kiyaga","sequence":"additional","affiliation":[{"name":"Ministry of Health, Kampala, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Kabanda","sequence":"additional","affiliation":[{"name":"Centers for Diseases Control and Prevention - Uganda, Entebbe, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mina","family":"Ssali","sequence":"additional","affiliation":[{"name":"Ministry of Health, Kampala, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David R","family":"Boulware","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David B","family":"Meya","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda"},{"name":"Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA"},{"name":"School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,11,3]]},"reference":[{"key":"2020122210292839400_CIT0001","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1016\/S1473-3099(17)30243-8","article-title":"Global burden of disease of HIV-associated cryptococcal meningitis: an updated analysis","volume":"17","author":"Rajasingham","year":"2017","journal-title":"Lancet Infect 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