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Emerging Infections Network Survey of Screening for Cryptococcal Antigenemia, United States, 2024

Summary

Researchers surveyed infectious disease doctors across the United States about how often they screen HIV patients for cryptococcal infections using a simple blood test. They found that only about one-third to two-thirds of doctors regularly perform this screening despite guidelines recommending it. Many doctors expressed uncertainty about whether the screening is beneficial or weren’t sure about the official recommendations, suggesting a need for better education about this potentially life-saving test.

Background

Cryptococcosis is a severe fungal disease caused by Cryptococcus, with approximately 3.4-6.5 cases per 100,000 population annually in the United States, and about one-third of cases associated with HIV. Cryptococcal antigen (CrAg) testing is a simple, rapid, and highly accurate diagnostic method that can detect early asymptomatic infection weeks to months before symptom onset. US federal guidelines recommend routine CrAg screening for persons with HIV and CD4 counts ≤200 cells/mm³, but limited data exist about CrAg screening practices in the United States.

Objective

To assess CrAg screening practices among infectious disease specialists in the United States and identify potential barriers to screening implementation. The study aimed to gain preliminary insights about CrAg screening use for patients initiating antiretroviral therapy (ART) and determine factors preventing adherence to screening guidelines.

Results

Of 215 respondents, 33% reported typically obtaining CrAg screening for patients with CD4 counts <200 cells/mm³ and 63% for counts <100 cells/mm³ when newly initiating ART. Primary barriers to screening included uncertainty about benefits (42%) and uncertainty about recommendations (32%). Most respondents (79-80%) reported appropriate follow-up procedures for positive CrAg results, including lumbar puncture and cerebrospinal fluid testing.

Conclusion

The survey revealed moderate adherence to national and international CrAg screening guidelines among infectious disease providers, with significant uncertainty about screening benefits and recommendations representing key barriers. Educational initiatives and clarity regarding guideline differences could improve screening implementation and potentially reduce cryptocurrency-associated morbidity and mortality among HIV-infected patients.
  • Published in:Emerging Infectious Diseases,
  • Study Type:Survey,
  • Source: PMID: 40562736, DOI: 10.3201/eid3107.250295
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