Guidelines for the prevention, diagnosis and management of cryptococcal meningitis and disseminated cryptococcosis in HIV-infected patients

While the developed world has seen a substantial decline in incidence rates of CC after the advent of highly active antiretroviral treatment (HAART), the enormity of the burden of AIDS on the African sub-continent and the anticipated delays in achieving full coverage of antiretroviral therapy (ART) programmes imply that CC will continue to cause mortality among our population for years to come. The prognosis of patients with cryptococcal meningitis was very poor prior to the availability of ART, but present survival rates in the context of ART co-administration are much improved. Consequently it has become essential to improve the initial acute management of CC in order to maximise the patient's chances of initial survival and subsequent entry into the ART treatment programme. Existing international guidelines for the management of cryptococcosis are written for different geographical and clinical contexts and may be impracticable for implementation in sub-Saharan Africa given limited availability of drugs and other resources.