ArticleWorld journal of virology2025
Uptake of lumbar puncture and mortality among patients with advanced human immunodeficiency virus disease who screened for serum cryptococcal-antigen in Africa.
Article in World journal of virology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe World Health Organization (WHO) recommends lumbar puncture (LP) procedures to assess the diagnosis of cryptococcal meningitis (CM) among patients with advanced human immunodeficiency virus (HIV) disease (AHD) with positive serum cryptococcal antigen (CrAg) and do not have evidence of CM.
aimTo estimate pooled prevalence of uptake of LP, CM and mortality among patients with AHD.
methodsPubMed, Cochrane Library and EMBASE were searched for articles published between January 2011 and December 2024. LP uptake was defined as percentage of people who underwent LP procedures among those with AHD (CD4 ≤ 200 cells/mm
resultsA total of 32 studies with 46890 people with AHD screened for serum CrAg and 2730 (5.8%) had positive serum CrAg. Overall, pooled prevalence of LP uptake was 67.7% (95%CI: 54.0-81.5). The overall pooled prevalence of CM was 54.3% (95%CI: 39.7-69.0), and mortality was 6.2% (95% CI: 4.5-8.0). There is disparities in the pooled prevalence of LP uptake with studies involving multiple sites having lower prevalence compared to those that involved single sites (54.8%
conclusionNearly three to five in 10 people with AHD with positive serum CrAg did not have LP procedures done, indicating significant gaps in identifying patients with CM. Establishing a confirmed diagnosis of CM is critical to avoid exposing patients to subtherapeutic levels of antifungals preemptively. Capacity to perform LP and patient refusals are among the reasons for not performing the procedure. Capacity building in training health care providers to perform LP procedures and professional counselling to obtain patient consent are critical for appropriate treatment to reduce mortality associated with CM infection.
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