Cryptococcal antigenemia in nigerian patients with advanced human immunodeficiency virus: influence of antiretroviral therapy adherence

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Oladele, R.O.
Akanmu, A.S.
Nwosu, A.O.
Ogunsola, F.T.
Richardson, M.D.
Denning, D.W.
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Oxford university press
Background. Cryptococcalmeningitishasahighmortalityinhumanimmunodeficiencyvirus(HIV)-infectedpersonsinAfrica. This is preventable with early screening and preemptive therapy. We evaluated the prevalence of cryptococcal disease by antigen testing, possible associated factors, and outcomes in HIV-infected patients being managed in a tertiary hospital in Lagos, Nigeria. Methods. Sera were collected from 214 consenting HIV-infected participants with CD4+ counts <250 cells/mm3, irrespective of their antiretroviral therapy (ART) status, between November 2014 and May 2015. A cryptococcal antigen (CrAg) lateral flow assay was used for testing. Pertinent clinical data were obtained from patients and their case notes. Results. Of the 214 participants, females (124; 57.9%) outnumbered males. Mean age was 41.3±9.4 (standard deviation) years. Themajority(204;95.3%)wereARTexperienced.ThemedianCD4+ cellcountwas160 cells/mm3 (interquartilerange,90–210).The overallseroprevalenceofcryptococcalantigenemiawas8.9%(19of214);6of61(9.8%)inthosewithCD4+ cellcounts<100 cells/mm3, 4 of 80 (5.0%) inthe 100–200 group, and 9 of 73 (12.3%)in 200–250 cells/mm3 group. Among ART-naive patients, 1 of 10 (10%) was CrAg positive. Twenty-seven of 214 (12.6%) had associated oral thrush. Potential baseline meningitis symptoms (3 of 214 [1.4%] experienced neck pain or stiffness and 21 of 214 [9.8%] experienced headache) were common in the study group, but the result was notstatisticallysignificantinrelation toCrAgpositivity.Twoof19 (10.5%) CrAg-positivepatientsdied, 10of19 (52.6%)were lostto follow up, and 7 of 19 (36.8%) were alive. Empirical fluconazole was routinely given to those with low CD4 counts <100 cells/mm3, which was unrelated to CrAg positivity (P=.018). Conclusions. We report a prevalence of 8.9% cryptococcal antigenemia in a setting where first-line antifungals are not readily available. We recommend CrAg screening for HIV-infected patients, even for patients on ART.
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Antiretroviral therapy , Cryptococcal antigenemia , Fluconazole , Hiv infection , Sub-saharan africa , Research Subject Categories::MEDICINE
Oladele, R.O, Akanmu, A.S, Nwosu, A.O, Ogunsola, F.T, Richardson, M.D. and Denning, D.W. (2016). Cryptococcal antigenaemia in Nigerian patients with advanced HIV: influence of ART adherence Open Forum Infectious Diseases. doi: 10.1093/ofid/ofw055.