Table 1 Characteristics of the 9 included studies
Author, year (reference) | Number of participants | Study type | Study duration | Age (years) | CD4 (cells/μL) | CrAg screening methods | CM diagnostic methods | Location | Therapeutic regimens | Primary outcomes | |
|---|---|---|---|---|---|---|---|---|---|---|---|
Incidence of CM | All-cause mortality | ||||||||||
Chariyalertsak, 2002 [18] | 129 | Prospective study | 104 weeks | 18 ~ 60 | <200 | Not report | Fungal culture, a histopathological examination, or buffy coat smear | Thailand | 63 for oral itraconazole (200 mg/day) as group 1; 66 for matched placebo as group 2 | 0 in group 1; 7 in group 2 | 12 in group 1; 11 in group 2 |
Manfredi, 1997 [19] | 249 | Retrospective study | 6 years | 22 ~ 59 | <200 | Not report | Specific polysaccharide antigen detection from body fluids | Italy | 128 for oral fluconazole (100 mg/d every third week) as group 1; 121 for no antifungal treatment as group 2 | 2 in group 1; 9 in group 2 | 12 in group 1; 13 in group 2 |
Parkes-Ratanshi, 2011 [20] | 1519 | Prospective study | 42 months | Not report | <200 | Not report | CrAg titre> 1:8 on two occasions, or a positive CSF CrAg or Cryptococcus neoformans grown from blood or CSF culture | Uganda | 760 fluconazole 200 mg 3 times per week for minimum 12 weeks as group 1; 759 allocated to placebo as group 2 | 1 in group 1; 18 in group 2 | 0 in group 1; 7 in group 2 |
McKinsey, 1999 [21] | 295 | Randomized, placebo-Controlled study | Not report | ≥13 | <150 | Not report | Fungal culture | Not report | 149 for itraconazole capsules (200 mg/day) as group 1; 146 for matched placebo as 2 | 1 in group 1; 8 in group 2 | 32 in group 1; 21 in group 2 |
Meya, 2010 [22] | 584 | Prospective study | 30 months | ≥18 | <200 | Not report | Not report | Uganda | Fluconazole (200 ~ 400 mg) for 2 ~ 4 weeks | 3 in CrAg+ persons and 0 in CrAg- persons | 6 in CrAg+ persons and 0 in CrAg- persons |
Kapoor, 2015 [23] | 72 | Retrospective study | 15 months | ≥18 | <200 | LFA | Positive CSF India ink | Sub-Saharan Africa | 800 mg fluconazole orally for 2 weeks, followed by 400 mg orally for 2 weeks | 0 in CrAg+ persons and 1 in CrAg- persons | 2 in CrAg+ persons and 8 in CrAg- persons |
Govender, 2015a [1] | 1079 | Retrospective study | 19 months | Not report | < 200 | LA or the Latex-Cryptococcus antigen detection system | CrAg detected in CSF | South Africa | Fluconazole ranging from 400 to 800 mg per day for at least 3 months | unknow in persons with CD4 < 200 | unknow in persons with CD4 < 200 |
Beyene, 2017 [10] | 783 | Prospective study | 18 months | > 14 | ≤150 | LFA | CSF CrAg | Ethiopia | Fluconazole 800 mg/day 2 weeks, followed by 400 mg/day 8 weeks | 2 in CrAg+ persons and 0 in CrAg- persons | 4 in CrAg+ persons and 0 in CrAg- persons |
Borges, 2019 [24] | 214 | Prospective study | 36 months | > 17 | < 200 | LFA | India ink microscopy on the CSF, CSF CrAg test and fungal culture | Brazil | Fluconazole 900 mg for 2 weeks, 450 mg for 8 to 10 weeks and a subsequent maintenance dose of 150–300 mg | 1 in CrAg+ persons with antifungal treatment and 0 in CrAg+ persons without intervention | 2 in CrAg+ persons |