What is the prevalence CNS cryptococcosis in HIV infection?

Updated: Jan 08, 2020
  • Author: Felicia J Gliksman, DO, MPH; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Answer

Cryptococcus is ubiquitous in the environment. Among HIV-infected patients in the United States, the annual incidence of cryptococcosis is 2–7 cases per 1000, with up to 89% occurring as a CNS manifestation. [1] It is the fourth most common cause of opportunistic infections (after Pneumocystis jiroveci, cytomegalovirus [CMV], and mycobacteria), and CNS manifestations (66–89%) are by far more common than manifestations in other organs. Its incidence has declined recently because of widespread use of antifungal and antiretroviral agents. [2]  In the United States, the prevalence of cryptococcal antigenemia is 2.9% in HIV-infected patients with CD4 counts 3</ref>

Worldwide, approximately 1 million cases of HIV-associated cryptococcol meningitis occur annually and disease accounts for more than 600,000 deaths. In developed countries, the widespread use of highly active antiretroviral therapy (HAART) has lowered the incidence of cryptococcosis, but the incidence and mortality of the disease remain extremely high in areas with uncontrolled HIV disease and limited access to HAART or health care. [4]

Of patients with AIDS in the United States, cryptococcal meningitis occurs more commonly in African Americans than in whites. [2] However, a case-controlled study did not find an association between cryptococcal infection and race, suggesting that race may just be a surrogate for the presence of other conditions or exposures.

CNS cryptococcosis is rare in children with AIDS.


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