Bibliographic Info
Recommendation
Certainty of evidence
Moderate
All people living with HIV with a positive cryptococcal antigen result on screening should be carefully evaluated for signs and symptoms of meningitis and undergo a lumbar puncture, if feasible, with cerebrospinal fluid (CSF) examination and India ink or CSF cryptococcal antigen assay to exclude active cryptococcal disease. India ink has low sensitivity, and a negative result on India ink should be confirmed by CSF cryptococcal antigen testing. When cryptococcal antigen screening is not available, fluconazole primary prophylaxis should be given to adults and adolescents living with HIV who have a CD4 count <100 cells/mm3
Notes and Remarks
Screening for cryptococcal antigen is the optimal approach for guiding resources in a public health approach and is the preferred approach for identifying risk of progression to disease when managing people presenting with advanced HIV disease.
Also Featured In
This recommendation also appears in the following guidelines:
Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach
Guidelines for diagnosing, preventing and managing cryptococcal disease among adults, adolescents and children living with HIV.