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Cryptococcal antigenaemia — DTM&H MCQ

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HardHIV in TropicsCryptococcal antigenaemiaDTM&H

An HIV-positive woman in Zambia with CD4 30 has positive serum CrAg but no headache or neck stiffness. LP shows normal CSF with negative India ink. What is management?

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Correct answer: C — Fluconazole 800 mg daily for 2 weeks then 400 mg for 8 weeks, then ART

Positive serum CrAg with negative CSF = cryptococcal antigenaemia without meningitis. Pre-emptive high-dose fluconazole prevents progression to meningitis (which occurs in ~25% if untreated). REMSTART trial showed CrAg screening plus pre-emptive fluconazole reduces mortality. ART starts ~2 weeks after fluconazole.

Reference: WHO Cryptococcal Guidelines 2022; REMSTART trial