lobal burden of cryptococcal meningitis among persons living with HIV/AIDS. AIDS.

lobal burden of cryptococcal meningitis among persons living with HIV/AIDS. AIDS.

Cryptococcal meningitis is one of the most important HIV-related opportunistic infections, especially in the developing world. In order to help develop global strategies and priorities for prevention and treatment, it is important to estimate the burden of cryptococcal meningitis. Par and colleagues undertook a global burden of disease estimation using published studies. They used the median incidence rate of available studies in a geographic region to estimate the region-specific cryptococcal meningitis incidence; this was multiplied by the 2007 Joint United Nations Programme on HIV/AIDS (UNAIDS) HIV population estimate for each region to estimate cryptococcal meningitis cases. To estimate deaths, the authors assumed a 9% 3-month case-fatality rate among high-income regions, a 55% rate among low-income and middle-income regions, and a 70% rate in sub-Saharan Africa, based on studies published in these areas and expert opinion. Published incidence ranged from 0.04 to 12% per year among persons with HIV. Sub-Saharan Africa had the highest yearly burden estimate (median incidence 3.2%, 720 000 cases; range, 144 000-1.3 million). Median incidence was lowest in Western and Central Europe and Oceania (

This study estimated that deaths due to cryptococcal meningitis in sub-Saharan Africa may be exceeding those due to tuberculosis. This highlights the substantial disease burden of cryptococcal meningitis and the urgent need to improve diagnostic capacity, expand treatment options, and identify preventive measures. One strategy would promote early detection using the serum cryptococcal antigen test and treatment of asymptomatic or latent cryptococcal infection with fluconazole. Expanding access to antiretroviral treatment is likely helping now to reduce the risk of cryptococcal disease, but disease burden remains very high and serious attention needs to be directed to better public health and clinical management of this disease.