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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 to understand how often they test HIV patients for cryptococcal antigen, a fungal infection that can be serious. The study found that doctors don’t consistently follow recommended screening guidelines, with many uncertain about the benefits of testing. Key barriers included confusion about testing recommendations and concerns about delaying HIV treatment, suggesting that doctors need better education about the importance of early detection.

Background

Cryptococcosis is a severe disease caused by environmental fungus Cryptococcus, affecting approximately 3.4-6.5 cases per 100,000 population annually in the United States, with about one-third of patients having HIV. Cryptococcal antigen (CrAg) testing is a simple, rapid, inexpensive, 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.

Objective

To assess current practices and identify barriers to cryptococcal antigen screening among infectious disease specialists in the United States for patients initiating HIV antiretroviral therapy.

Results

Of 215 respondents, 33% reported typically obtaining screening for patients with CD4 counts <200 cells/mm³ and 63% for counts <100 cells/mm³ when newly initiating antiretroviral therapy. The primary barriers to screening were uncertainty about benefits (42%) and recommendations (32%). Most respondents (79%) reported performing lumbar puncture and cerebrospinal fluid testing for patients with positive CrAg results.

Conclusion

Moderate adherence to CrAg screening guidelines was observed, with significant uncertainty among providers about screening benefits and recommendations, suggesting opportunities for targeted education and implementation strategies to improve adherence to national guidelines.
  • Published in:Emerging Infectious Diseases,
  • Study Type:Survey,
  • Source: PMID: 40562736, DOI: 10.3201/eid3107.250295
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