Overview

Cryptococcal disease is an opportunistic infection that occurs primarily among people with advanced HIV disease and is an important cause of morbidity and mortality in this group. By far the most common presentation of cryptococcal disease is cryptococcal meningitis, which accounts for an estimated 15% of all AIDS-related deaths globally, three quarters of which are in sub-Saharan Africa.

These guidelines provide recommendations and good practice guidance on the optimal approach to diagnosing cryptococcal meningitis, strategies for preventing invasive cryptococcal disease through cryptococcal antigen screening and pre-emptive fluconazole therapy, treating cryptococcal meningitis with combination antifungal therapy regimens, preventing, monitoring and managing amphotericin B drug toxicity, recommendations against adjunctive therapy with systemic corticosteroids and recommendations on the timing of antiretroviral therapy (ART) initiation.

Contents

• Definition of Key Terms
• Acknowledgements
• 1. Executive Summary
  • Recommendations
  • Good practice principles
• 2. Background
  • 2.1. Objectives
  • 2.2. Target audience
  • 2.3. Guiding principles
• 3. Key Recommendations, Rationale and Evidence Summary
  • 3.1. Diagnosing cryptococcal disease
  • 3.2. Screening for and preventing cryptococcal disease
  • 3.3. Induction, consolidation and maintenance antifungal treatment regimens
  • 3.4. Adjunctive corticosteroids in treating HIV-associated cryptococcal meningitis
  • 3.5. Preventing, monitoring and managing amphotericin B toxicity
  • 3.6. Monitoring and managing people with cryptococcal meningitis
  • 3.7. Timing of ART initiation
  • 3.8. Discontinuing fluconazole maintenance treatment (secondary prophylaxis)
• 4. Implementation Challenges and Considerations
  • 4.1. Overview
  • 4.2. Access to diagnostics
  • 4.3. Access to medicines
  • 4.4. Educating and training health-care providers
• 5. Disseminating, Adapting and Implementing the Guidelines
• References
• ANNEX 1. Methods for developing the guidelines
• ANNEX 2. Summary of the Performance of Diagnostic Assays
• References

Suggested citation:

Guidelines on the diagnosis, prevention and management of cryptococcal disease in HIV-infected adults, adolescents and children: supplement to the 2016 consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO.

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