Rapid advice : diagnosis, prevention and management of cryptococcal disease in HIV-infected adults, adolescents and children : December 2011
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World Health Organization
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44 p.
This rapid advice provides evidence-based recommendations on the diagnosis, prevention and management of cryptococcal disease in HIV-infected adults, adolescents and children, with a particular focus on resource-limited settings where late HIV diagnosis and limited access to effective diagnosis and treatment contribute substantially to mortality. Developed through the WHO guideline process using systematic reviews, GRADE assessments, reviews of existing national guidelines, feasibility assessments and expert consultation, the document was issued to support countries updating HIV care and opportunistic infection policies while a comprehensive guideline was under development. The publication presents recommendations covering six priority areas: diagnosis of cryptococcal disease, screening and prevention, induction, consolidation and maintenance antifungal treatment, prevention and monitoring of amphotericin B toxicity, timing of antiretroviral therapy initiation, and discontinuation of maintenance treatment. It emphasizes earlier diagnosis through rapid cryptococcal antigen testing, consideration of targeted screening and pre-emptive therapy in high-risk populations, use of effective antifungal regimens, and standardized approaches to toxicity management. The guidance also outlines its objectives, intended audience, implementation considerations and the principles underpinning the recommendations, with the aim of improving survival and the quality of HIV care while identifying priorities for future clinical and operational research.
This rapid advice provides evidence-based recommendations on the diagnosis, prevention and management of cryptococcal disease in HIV-infected adults, adolescents and children, with a particular focus on resource-limited settings where late HIV diagnosis and limited access to effective diagnosis and treatment contribute substantially to mortality. Developed through the WHO guideline process using systematic reviews, GRADE assessments, reviews of existing national guidelines, feasibility assessments and expert consultation, the document was issued to support countries updating HIV care and opportunistic infection policies while a comprehensive guideline was under development. The publication presents recommendations covering six priority areas: diagnosis of cryptococcal disease, screening and prevention, induction, consolidation and maintenance antifungal treatment, prevention and monitoring of amphotericin B toxicity, timing of antiretroviral therapy initiation, and discontinuation of maintenance treatment. It emphasizes earlier diagnosis through rapid cryptococcal antigen testing, consideration of targeted screening and pre-emptive therapy in high-risk populations, use of effective antifungal regimens, and standardized approaches to toxicity management. The guidance also outlines its objectives, intended audience, implementation considerations and the principles underpinning the recommendations, with the aim of improving survival and the quality of HIV care while identifying priorities for future clinical and operational research.
Keywords
WHO guideline, HIV Infections, Anti-Retroviral Agents, AIDS-Related Opportunistic Infections, Meningitis, Cryptococcal, Adult, Adolescent, Child, Guideline, Developing Countries, Communicable Diseases and their Control, complications diagnosis, administration and dosage, diagnosis prevention and control