Comparison of Cryptococcal Antigenemia between Antiretroviral Naïve and Antiretroviral Experienced HIV Positive Patients at Two Hospitals in Ethiopia

Tafese Beyene, Yimtubezinash Woldeamanuel, Daniel Asrat, Gonfa Ayana, David R. Boulware

Research output: Contribution to journalArticlepeer-review

27 Scopus citations

Abstract

Background:Cryptococcal meningitis is a major cause of HIV/AIDS-related deaths in Africa. Cryptococcosis is a neglected killer. However, meningitis can be prevented by early cryptococcal antigen (CrAg) screening and preemptive antifungal treatment during a prolonged period of detectable, subclinical infection. We determined the prevalence of cryptococcal antigenemia in comparison to CD4 count and clinical symptoms.Methods:We surveyed 254 consenting HIV-infected participants to obtain demographic information and clinical history. Serum CrAg was measured by latex agglutination at two sites in the Oromia region of Ethiopia among all persons receiving a CD4 count.Results:Of the 254 participants, 127(50.0%) were ART-naïve, 121(47.6%) were ART-experienced, and 6(2.4%) were ART-defaulters. The prevalence of cryptococcal antigenemia was 10.2% overall being 14.2% among ART-naive, 4.1% among ART-experienced, and 50% (3/6) among ART-defaulters, irrespective of CD4 count. Cryptococcal antigenemia was more frequently detected from ART-naïve patients (p = 0.012) and ART-defaulters (p = 0.001) compared with ART-experienced. Serum CrAg positivity was 20.9% in persons with CD4≤150 cells/μL, 12.2% in 151-200 cells/μL, 5.8% among 201-350 CD4/μL, and none above 350 cells/μL. Potential meningitis symptoms were common in the outpatient cohort irrespective of CrAg-status, with only fever and altered mental status statistically more common in CrAg-positive compared to CrAg-negative persons (P<0.05), yet no symptom had a positive predictive value >33%.Conclusion:We report a 20.9% cryptococcal antigenemia prevalence among those with CD4+ T cells count ≤150 cells/μL, irrespective of ART status, with even higher CrAg prevalence in ART-naïves and ART-defaulters. These groups are target populations for CrAg screening at entry into HIV care.

Original languageEnglish (US)
Article numbere75585
JournalPloS one
Volume8
Issue number10
DOIs
StatePublished - Oct 4 2013

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