Objective: Cryptococcal meningitis is an important cause of morbidity and mortality in HIV infected individuals. In the era of universal antiretroviral therapy, the incidence of immune reconstitution inflammatory syndrome (IRIS) related cryptococcal meningitis has increased. Detection of serum cryptococcal antigen in asymptomatic PLHIV (People Living With HIV) and preemptive treatment with fluconazole can decrease the burden of cryptococcal disease. We conducted this study to find the prevalence of asymptomatic cryptococcal antigenemia in India and its correlation with mortality in PLHIV.

Method and Materials: This was a prospective observational study. HIV infected ART naïve patients with age of ≥ 18 years who had CD4 counts ≤ 100 /μL were included and serum cryptococcal antigen test was done. These patients were followed for six months to look for the development of Cryptococcal meningitis and mortality.

Results: A total of 116 patients were analyzed. Asymptomatic cryptococcal antigenemia was detected in 5.17% of patients and is correlated with increased risk of cryptococcal meningitis and mortality on follow-up in PLHIV.

Conclusion: Serum cryptococcal antigen positivity is correlated with an increased risk of Cryptococcal meningitis and mortality in PLHIV. We recommend the screening of asymptomatic PLHIV with CD4 ≤ 100/μL for serum cryptococcal antigen, so that pre-emptive treatment can be initiated to reduce morbidity and mortality.

目的：隐球菌脑膜炎是 HIV 感染者发病和死亡的一个重要原因。在普遍抗逆转录病毒治疗的时代，免疫重建炎症综合征（IRIS）相关的隐球菌脑膜炎的发病率有所增加。在无症状 PLHIV（艾滋病病毒感染者）中检测血清隐球菌抗原并使用氟康唑进行抢先治疗可以减轻隐球菌疾病的负担。我们进行了这项研究，以了解印度无症状隐球菌抗原血症的流行情况及其与 PLHIV 死亡率的相关性。

方法和材料：这是一项前瞻性观察研究。年龄≥ 18 岁且 CD4 计数≤ 100 /μL 的 HIV 感染 ART 初治患者包括在内，并进行了血清隐球菌抗原检测。这些患者被跟踪了六个月，以寻找隐球菌脑膜炎的发展和死亡率。

结果：共分析了 116 名患者。在 5.17% 的患者中检测到无症状的隐球菌抗原血症，这与 PLHIV 的隐球菌脑膜炎风险和随访死亡率增加相关。

结论：血清隐球菌抗原阳性与隐球菌脑膜炎的风险增加和 PLHIV 的死亡率相关。我们建议对CD4≤100/μL的无症状PLHIV患者进行血清隐球菌抗原筛查，以启动抢先治疗，降低发病率和死亡率。