Preventing invasive cryptococcal disease through active screening for cryptococcal antigenemia in people living with advanced HIV

Cryptococcal meningitis remains a significant cause of morbidity and mortality among people living with HIV (PLHIV), particularly in resource-limited settings. In South Africa, it is estimated that cryptococcal meningitis accounts for approximately 15% of AIDS-related deaths, underscoring its significant health burden. Despite advances in antiretroviral therapy (ART), individuals with CD4 counts below 200 cells/mm³ remain at elevated risk for opportunistic infections, including cryptococcal disease caused by Cryptococcus neoformans (and rarely, Cryptococcus gattii). Cryptococcal fungi are found worldwide in soil, bird droppings, associated with trees and found in decaying organic matter. Cryptococcal disease mostly occurs in people with defective T-cell mediated immunity, with HIV infection, the major risk factor. Other risk factors include solid organ transplant recipients, and individuals taking immunosuppressive drugs