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.
Since Cryptococcus neoformans will most 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 ARV therapy before the immune system becomes impaired.
For people who do have compromised immune systems (less than 50 CD4 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, most experts don't 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 5-8% 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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