Screening for Cryptococcal Antigenemia

Cryptococcosis is a severe fungal disease that typically affects people who have immunosuppressive conditions. In the United States, the proportion of cryptococcosis cases among people with HIV has decreased in the last 2 decades, while the proportion of cases in transplant recipients, people with other immunosuppressing conditions, and seemingly immunocompetent people has increased (PLoS One 2012, CID 2018, PLoS One 2013). Cryptococcal antigen (CrAg) testing can detect early, asymptomatic cryptococcal infection in patients with HIV.

The purpose of this survey is to help us understand how frequently certain patient groups are screened for cryptococcal antigenemia in the United States.

Setting/facility where you primarily practice: Setting Community Non-university teaching University VA hospital or DOD City/county/public Children's hospital Cancer facility Outpatient only Other Respondent type: Respondent ID physician (primarily for adults) ID physician (primarily for children) Nurse practitioner Physician assistant/associate Other Besides adult or adolescent patients with advanced HIV, do you think that other patient groups should be routinely screened for cryptococcal antigenemia? Yes, [please specify below]      No       Not sure  I have not cared for or evaluated any adult or adolescent patients with HIV in the past year - stop here & click submit below How frequently do you obtain cryptococcal antigen (CrAg) testing on blood for the following groups of adult or adolescent patients with HIV? CD4 count <100 cells/mm3 CD4 count <200 cells/mm3 Newly initiating ART Select Never Rarely Sometimes Often Always Select Never Rarely Sometimes Often Always Re-initiating ART Select Never Rarely Sometimes Often Always Select Never Rarely Sometimes Often Always Experiencing ART failure Select Never Rarely Sometimes Often Always Select Never Rarely Sometimes Often Always Seriously ill, regardless of ART status Select Never Rarely Sometimes Often Always Select Never Rarely Sometimes Often Always Which barriers, if any, concern you or prevent you from obtaining cryptococcal antigen (CrAg) testing for patients with HIV who are initiating or reinitiating antiretroviral therapy (ART) and have a CD4 cell count <200 cells/mm3?    [Select all that apply below] CrAg testing is not available at my facility/institution Long turnaround time for send-out CrAg testing Uncertainty around CrAg screening recommendations Difficulty of interpreting CrAg test results Unsure of benefit of CrAg screening Concern about delaying ART initiation or re-initiation Challenges with insurance coverage Other, specify below None of these Which of the following would you consider doing for a patient with a positive CrAg screening test result?   [select all that apply below] Not applicable / I don’t order CrAg testing Evaluate for symptoms of meningitis Perform lumbar puncture and order cerebrospinal fluid (CSF) testing for Cryptococcus or CrAg Obtain CrAg titer Treatment with fluconazole while awaiting CSF results Other, specify below None of these Any final comments about CrAg screening:

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