Because Cryptococcus neoformans can be found in many parts of
the environment, it is very difficult to prevent coming into contact with
the fungus. Moreover, Cryptococcus neoformans can live in a person's
body for many months or possibly years before it causes disease, depending
on the health of the person's immune system.
Because Cryptococcus neoformans will must likely lead to cryptococcal
meningitis in people with damaged immune systems, the best possible way
to prevent this disease is to keep the immune system healthy. This includes
starting anti-HIV therapy before the immune system becomes impaired.
For people who do have compromised immune systems (less than 50 T-cells),
it is possible to take fluconazole (Diflucan®), an oral
pill (200 mg) taken once a day, to help prevent cryptococcal meningitis
and other serious fungal infections. However, not all experts recommend
using fluconazole to prevent this disease. This is because cryptococcal
meningitis is quite rare. As explained in the first section of this lesson,
only 5% of HIV-positive people with severely suppressed immune systems
experience this disease. Because fluconazole can cause side effects and
may cause Cryptococcus neoformans or other fungi to become resistant
to the drug – which would prevent fluconazole from being effective
when it is most needed – many experts are concerned that the risks
of using this drug on a long-term basis might outweigh the its potential
benefits.
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