Despite significant and continuous progress in the expansion of antiretroviral therapy (ART) programs globally, reductions in mortality from acquired immunodeficiency syndrome (AIDS) have slowed in many contexts. Currently, it is estimated that one third of individuals receiving care for human immunodeficiency virus (HIV) are living with advanced HIV disease (AHD), defined as a CD4+ T cell count below 200 cells/μL (Stage 3 or 4). These individuals are at increased risk of opportunistic infections and death, yet often experience challenges in continuing to engage in care.
Cryptococcal meningitis (CM), a critical fungal opportunistic infection, is the second-most common cause of HIV-related mortality in sub-Saharan Africa, where it accounts for an estimated 15-20% of HIV-related deaths. To refocus on AHD-related mortality, a collaboration of global stakeholders developed standard guidelines under the Ending Cryptococcal Meningitis Death by 2030 Framework in 2021.