Management of cryptococcal infection
This indicator measures the screening and treatment cascade for cryptococcal infection among people with advanced HIV disease: the proportion of people with CD4 count below 200 cells/mm3 screened for cryptococcal infection; the proportion of people who screened positive for cryptococcal infection; and the proportion of people who were treated for cryptococcal infection among those who screened positive.
To reduce AIDS-related deaths, HIV programmes must emphasize identification of people with advanced HIV disease, prevention of opportunistic infections, and treatment of opportunistic infections. Cryptococcal infections are responsible for substantial mortality and morbidity among people living with HIV, particularly in people with a CD4 cell count below 200 cells/mm3 (advanced HIV disease). This indicator supports the surveillance of screening, diagnosis and treatment of cryptococcal infection, one of the most common opportunistic infections among people with advanced HIV disease.
A. Number of people living with HIV with CD4 count below 200 cells/mm3 with cryptococcal infection who received treatment.
B. Number of people living with HIV and CD4 count below 200 cells/mm3 who tested positive for cryptococcal infection.
C. Number of people living with HIV and CD4 count below 200 cells/mm3 who were tested for cryptococcal infection.
A. Number of people living with HIV and CD4 count below 200 cells/mm3 who tested positive for cryptococcal infection.
B. Number of people living with HIV and CD4 count below 200 cells/mm3 who were tested for cryptococcal infection.
C. Number of people living with HIV with CD4 count below 200 cells/mm3.
Numerator A/Denominator A
Numerator B/Denominator B
Numerator C/Denominator C
Based on data from laboratory information systems and from the records of people in treatment. Data can be compiled from health services registries, case report forms and laboratory information systems.
Data can include people with a CD4 test at or within 1 month of initial diagnosis, and also people with a repeat CD4 test at re-enrolment in care or at any time during antiretroviral therapy.
This indicator will improve surveillance of a key opportunistic infection, improve identification of people with advanced HIV disease, and contribute to understanding the causes of death among people living with HIV.
A weakness of this indicator is that only cryptococcal infection is monitored. Other common opportunistic infections, such as tuberculosis, histoplasmosis and Pneumocystis jirovecii infections, are not included.
Izco S, Garcia-Basteiro AL, Denning DW, Boulware DR, Penn-Nicholson A, Letang E. Management of advanced HIV disease in Africa. Lancet HIV. 2023;10(6):e358–e360.
Rajasingham R, Govender NP, Jordan A, Loyse A, Shroufi A, Denning DW, et al. The global burden of HIV-associated cryptococcal infection in adults in 2020: a modelling analysis. Lancet Infect Dis. 2022;22(12):1748–1755.
Guidelines for diagnosing, preventing and managing cryptococcal disease among adults, adolescents and children living with HIV. Geneva: World Health Organization; 2022 (https://www.who.int/publications-detail-redirect/9789240052178, accessed 15 October 2023).
Guidelines for managing advanced HIV disease and rapid initiation of antiretroviral therapy. Geneva: World Health Organization; 2017 (https://www.who.int/publications/i/item/9789241550062, accessed 12 October 2023).