Background Cryptococcal meningitis is a major cause of death among people living with HIV (PLWH). Cryptococcal antigen (CrAg) testing of asymptomatic patients is an important public health measure to reduce mortality in high incidence areas. However, limited data exists on CrAg prevalence in Central America. Methods We conducted a prospective cohort study at the two largest HIV clinics and hospitals in Honduras. CrAg in serum and cerebrospinal fluid was performed in individuals living with HIV who had CD4 ≤ 100 cells/mm 3 between 2017-2018. After CrAg testing, individuals were followed up for 12 months to assess mortality using adjusted cox proportional hazard models. Results A total of 220 PLWH were tested for CrAg of which 12.7% (n=28) tested positive. CrAg prevalence was higher among hospitalized individuals in 40% (n=10 of 25) of the cases. The proportion (35.8%) of individuals taking ART was significantly (p<0.01) lower among those who tested positive for CrAg. Overall mortality among the cohort was 11.4% (n=25 of 220) by 12 months. CrAg-positive cases were at a significantly higher risk of death [aHR: 2.69, 95%: 1.07-6.84] when compared to CrAg-negative participants. Conclusions CrAg prevalence in Honduras was high among PLWH. Moreover, individuals who tested positive for CrAg testing were at a higher risk of death. Systemic CrAg of PLWH with a CD4 ≤ 100 cells/mm 3 should be routinely performed in Central America.
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