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

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dc.contributor.authorOladele, R.O.
dc.contributor.authorAkanmu, A.S.
dc.contributor.authorNwosu, A.O.
dc.contributor.authorOgunsola, F.T.
dc.contributor.authorRichardson, M.D.
dc.contributor.authorDenning, D.W.
dc.date.accessioned2019-12-09T09:56:16Z
dc.date.available2019-12-09T09:56:16Z
dc.date.issued2016
dc.descriptionStaff publicationsen_US
dc.description.abstractBackground. 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.en_US
dc.identifier.citationOladele, 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.en_US
dc.identifier.otherdoi: 10.1093/ofid/ofw055.
dc.identifier.urihttps://www.google.com/search?q=Cryptococcal+Antigenemia+in+Nigerian+Patients+With+Advanced+Human+Immunode%EF%AC%81ciency+Virus%3A+In%EF%AC%82uence+of+Antiretroviral+Therapy+Adherence&oq=Cryptococcal+Antigenemia+in+Nigerian+Patients+With+Advanced+Human+Immunode%EF%AC%81ciency+Virus%3A+In%EF%AC%82uence+of+Antiretroviral+Therapy+Adherence&aqs=chrome..69i57.739j0j9&sourceid=chrome&ie=UTF-8
dc.identifier.urihttps://ir.unilag.edu.ng/handle/123456789/7046
dc.language.isoenen_US
dc.publisherOxford university pressen_US
dc.subjectAntiretroviral therapyen_US
dc.subjectCryptococcal antigenemiaen_US
dc.subjectFluconazoleen_US
dc.subjectHiv infectionen_US
dc.subjectSub-saharan africaen_US
dc.subjectResearch Subject Categories::MEDICINEen_US
dc.titleCryptococcal antigenemia in nigerian patients with advanced human immunodeficiency virus: influence of antiretroviral therapy adherenceen_US
dc.typeArticleen_US
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