Screening

Screening in people living with HIV

Blood cryptococcal polysaccharide antigen (CrAg) screening is recommended for people living with HIV with CD4 counts 100 cells/mm³.​[20][23][32]​​

CrAg screening may also be considered at a higher CD4 count threshold of <200 cells/microlitre.[23]​​

According to the WHO, when a patient's CrAg test is positive, the first consideration should be to determine if they have signs/symptoms of meningitis. If meningitis is suspected, the patient should have a lumbar puncture to determine if they have cryptococcal meningitis.[23]

In the US, routine serum CrAg screening is recommended for people meeting the following criteria:[20]

  • New diagnosis of HIV, and

  • No overt clinical signs of meningitis, and

  • CD4 count ≤100 cells/mm³, particularly in those with CD4 count ≤50 cells/mm³.

US guidelines recommend lumbar puncture in all HIV-positive people with a positive serum CrAg test.[20]

Screening in people without HIV

Cryptococcal antigen screening is not recommended in people without HIV.[32]

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