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

Summary

This survey asked infectious disease doctors across the United States about their use of a simple blood test (cryptococcal antigen screening) for HIV patients. The test can detect a dangerous fungal infection weeks before symptoms appear, allowing for early treatment. However, the survey found that many doctors are not using this recommended test regularly, primarily because they are unsure about its benefits and are confused about screening guidelines.

Background

Cryptococcosis is a severe disease caused by Cryptococcus that causes approximately 3.4-6.5 cases per 100,000 population annually in the United States, with 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 actual screening practices.

Objective

To gain preliminary insights about CrAg screening use among infectious disease providers and identify potential barriers to implementation of screening recommendations.

Results

Only 33% of respondents reported typically obtaining CrAg screening for patients with CD4 counts <200 cells/mm³ when newly initiating antiretroviral therapy, while 63% screened for counts <100 cells/mm³. Primary barriers included uncertainty about screening benefits (42%) and uncertainty about recommendations (32%). Most respondents (79%) reported performing lumbar punctures for positive CrAg tests, and 77% evaluated for meningitis symptoms.

Conclusion

The survey revealed moderate adherence to CrAg screening guidelines and identified significant knowledge gaps among infectious disease providers. Substantial uncertainty about screening benefits and recommendations suggests opportunities for targeted education and increased implementation of screening practices.
  • Published in:Emerging Infectious Diseases,
  • Study Type:Survey,
  • Source: PMID: 40562736, DOI: 10.3201/eid3107.250295
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