HIV AIDS and Cryptococcal Disease

A study has recently been done by Rosalind Parkes-Ratanshi and her colleagues into the prevalence and development of cryptococcal disease amongst people who have been diagnosed as being HIV positive. It was found that people with HIV AIDS who previously tested negative for the cryptococcal antigen, known as CrAg, tend to have a higher likelihood of developing cryptococcal disease over a period of time without the benefit of a prophylaxis treatment.

There were two groups of HIV AIDS infected people in the study. Both a placebo group and a test group were established and matched as required for a study to produce a statistically significant result that can be verified. The placebo group consisted of 759 patients and the experimental group consisted of 760 patients. Most of these patients were still awaiting antiretroviral treatment. The difference in group size could have been caused by a number of factors. For instance, participants could have elected to leave the study. It is also possible that, since the participants' CD4 count was already so low, a few people could have succumbed to the viruses that their drastically compromised immune systems were unable to overcome. During the course of the study, a much higher percentage of the placebo group (i.e. the test subjects who were not given the propylaxis treatment) developed cryptococcal disease than in the experimental group. This is a good indication that without this treatment a good number of people who do contract HIV AIDS will also develop cryptococcal disease.

It was found that treatment with the prophylaxis might not be a cost-effective solution if all patients with a CD4 count of less than 100 cells per millilitre were to be treated. An alternative has been suggested, however. It was suggested that health officials put a system in place whereby patients are screened for the cryptococcal antigen, CrAg, and treated for it if necessary, which does not include the prophylaxis component. It is thought that this will be enough of an intervention to reduce cryptococcal disease-related morbidity and mortality. It has also been suggested that improved access to antiretroviral treatment will also improve the situation. Furthermore, it has been suggested that the waiting period between diagnosis and the start of antiretroviral treatment be shortened. Other suggestions include the use of a more sensitive screening test for the cryptococcal antigen so that treatment of the condition can be started at an earlier stage. One has already been developed in the United States.

The end results of this study are fairly wide-reaching. It has been found that people infected with the HIV AIDS virus are more likely to develop cryptococcal disease without the prophylaxis treatment than with treatment. It will likely lead to improved treatment and diagnostic procedures for the condition if the suggestions that have been made are considered and put into practice. The concept of treating all HIV AIDS patients for cryptococcal disease-prevention with the prophylaxis discovered to be effective has been labelled as too expensive. Therefore, other alternatives are being considered that will be more cost-effective on a national scale.

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