Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
National Institute for Communicable Diseases, National Health Laboratory Service and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Lancet Infect Dis. 2022 Dec;22(12):1748-1755. doi: 10.1016/S1473-3099(22)00499-6. Epub 2022 Aug 29.
Cryptococcal meningitis is the most common cause of meningitis in adults living with HIV in sub-Saharan Africa. The estimates of national, regional, and global burden of cryptococcal meningitis are essential to guide prevention strategies and determine needs for diagnostic tests and treatments. We present a 2020 estimate of the global burden of HIV-associated cryptococcal infection (antigenaemia), cryptococcal meningitis, and cryptococcal-associated deaths.
We defined advanced HIV disease as adults with a CD4 count of less than 200 cells/μL, as this group is at highest risk for cryptococcosis. We used UNAIDS estimates (2019-20) and population-based HIV impact assessment surveys (2016-18) to estimate the number of adults with CD4 counts of less than 200 cells/μL at risk for cryptococcosis, by country and region. Secondly, we summarised cryptococcal antigenaemia prevalence in those with a CD4 count of less than 200 cells/μL by reviewing published literature. Thereafter, we calculated the number of cryptococcal antigen (CrAg)-positive people in each country and region by multiplying the number with advanced HIV disease at risk for cryptococcal infection by the cryptococcal antigenaemia prevalence of the respective country or region. We estimated progression from cryptococcal antigenaemia to meningitis or death based on estimates from the published literature.
We estimated that there were 4·3 million (IQR 3·0-4·8) adults with HIV and CD4 counts of less than 200 cells/μL globally in 2020. We calculated a mean global cryptococcal antigenaemia prevalence of 4·4% (95% CI 1·6-7·4) among HIV-positive people with CD4 counts of less than 200 cells/μL, corresponding to 179 000 cases (IQR 133 000-219 000) of cryptococcal antigenaemia globally in 2020. Annually, we estimated that there are 152 000 cases (111 000-185 000) of cryptococcal meningitis, resulting in 112 000 cryptococcal-related deaths (79 000-134 000). Globally, cryptococcal disease accounts for 19% (13-24) of AIDS-related mortality.
Despite a reduction in the estimated absolute global burden of HIV-associated cryptococcal meningitis compared with 2014, likely to be due to antiretroviral therapy expansion, cryptococcal disease still accounts for 19% of AIDS-related deaths, similar to 2014 estimates. To end cryptococcal meningitis deaths by 2030, cryptococcal diagnostics, meningitis treatments, and implementation of preventive screening are urgently needed.
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在撒哈拉以南非洲，隐球菌性脑膜炎是导致成人艾滋病毒感染者罹患脑膜炎的最常见原因。估算隐球菌性脑膜炎在国家、区域和全球范围内的负担对于指导预防策略以及确定诊断检测和治疗需求至关重要。我们提供了 2020 年全球艾滋病毒相关隐球菌感染（抗原血症）、隐球菌性脑膜炎和隐球菌相关死亡的负担估计。
我们将晚期 HIV 疾病定义为 CD4 计数<200 个细胞/μL 的成年人，因为这一人群最容易发生隐球菌病。我们使用 UNAIDS 的估计数（2019-20 年）和基于人群的 HIV 影响评估调查（2016-18 年），按国家和地区估算有 CD4 计数<200 个细胞/μL 且面临隐球菌病风险的成年人人数。其次，我们通过查阅已发表的文献，总结了 CD4 计数<200 个细胞/μL 的人群中隐球菌抗原血症的流行率。之后，我们将每种国家和地区的有晚期 HIV 疾病且面临隐球菌感染风险的人数乘以各自国家或地区的隐球菌抗原血症流行率，计算出每个国家和地区的隐球菌抗原阳性人数。我们根据已发表文献中的估计数，估算了从隐球菌抗原血症进展为脑膜炎或死亡的人数。
我们估计，2020 年全球有 430 万人（IQR，3.0-4.8）患有 HIV 且 CD4 计数<200 个细胞/μL。我们计算出，CD4 计数<200 个细胞/μL 的 HIV 阳性人群中，隐球菌抗原血症的全球平均流行率为 4.4%（95%CI，1.6-7.4），这相当于 2020 年全球有 179000 例（IQR，133000-219000）隐球菌抗原血症。每年，我们估计有 152000 例（111000-185000）隐球菌性脑膜炎病例，导致 112000 例（79000-134000）与隐球菌相关的死亡。全球范围内，隐球菌病占艾滋病相关死亡的 19%（13-24）。
尽管与 2014 年相比，全球与艾滋病毒相关的隐球菌性脑膜炎的估计绝对负担有所下降，这可能是由于抗逆转录病毒治疗的扩大，但隐球菌病仍然占艾滋病相关死亡的 19%，与 2014 年的估计数相似。为了在 2030 年前终结因隐球菌性脑膜炎导致的死亡，迫切需要隐球菌诊断检测、脑膜炎治疗以及实施预防性筛查。
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