Cryptococcal antigen (CrAg) screening and targeted preemptive fluconazole in antiretroviral-naive human immunodeficiency virus–infected adults with CD4 cell counts <100/μL seems promising as a strategy to reduce the burden of cryptococcal meningitis (CM). We searched MEDLINE, EMBASE, and Web of Science and used random-effect meta-analysis to assess the prevalence of blood CrAg positivity (31 studies; 35644 participants) and asymptomatic CM in CrAg-positive participants and the incidence of CM and the all-cause mortality rate in screened participants. The pooled prevalence of blood CrAg-positivity was 6% (95% confidence interval [CI], 5%–7%), and the prevalence of asymptomatic CM in CrAg-positive participants was 33% (95% CI, 21%–45%). The incidence of CM was 21.4% (95% CI, 11.6%–34.4%) without preemptive fluconazole and 5.7% (95% CI, 3.0%–9.7%) with preemptive fluconazole therapy initiated at 800 mg/d. In CrAg-positive participants, postscreening lumbar puncture before initiating preemptive fluconazole at 800 mg/d further reduced the incidence of CM to null and showed some survival benefits. However, the all-cause mortality rate remained significantly higher in CrAg-positive than in CrAg-negative participants (risk ratio, 2.2; 95% CI, 1.7–2.9; P < .001).

中文翻译：

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常规隐球菌抗原筛选和靶向抢先氟康唑治疗对未感染抗逆转录病毒的人类免疫缺陷病毒感染的CD4细胞计数<100 /μL的成年人的影响：系统评价和荟萃分析

抗天真的人类免疫缺陷病毒感染的隐球菌抗原（CrAg）筛查和靶向的先发性氟康唑可感染CD4细胞计数<100 /μL的成年人，有望作为减轻隐球菌性脑膜炎（CM）负担的策略。我们搜索了MEDLINE，EMBASE和Web of Science，并使用随机效应荟萃分析评估了CrAg阳性参与者中血液CrAg阳性（31个研究； 35644名参与者）和无症状CM的患病率以及CM和全导致被筛查参与者的死亡率。合并的血液中CrAg阳性患病率为6％（95％置信区间[CI]，5％–7％），而CrAg阳性参与者的无症状CM患病率为33％（95％CI，21％–45） ％）。在没有先发氟康唑的情况下，CM的发生率为21.4％（95％CI，11.6％–34.4％）和5.7％（95％CI，3.0％-9）。7％）的氟康唑抢先治疗开始剂量为800 mg / d。在CrAg阳性参与者中，在以800 mg / d的剂量抢先使用氟康唑之前，对腰穿进行筛查后，可将CM的发生率进一步降低至零，并显示出一定的生存益处。然而，CrAg阳性的全因死亡率仍显着高于CrAg阴性的参与者（风险比，2.2； 95％CI，1.7–2.9； P <.001）。