Objective Worldwide, HIV-associated cryptococcal meningitis affects approximately 1 million persons and causes 600,000 deaths each year mostly in sub-Sharan Africa. Limited data exist on cryptococcal meningitis and antigenemia in Nigeria, and most studies are geographically restricted. We determined the prevalence of cryptococcal antigenemia (CrAg) among HIV-infected treatment-naïve individuals in Nigeria. Design/Methods This was a retrospective, cross-sectional study across four geographic regions in Nigeria. We performed CrAg testing using a lateral flow immunoassay on archived whole blood samples collected from HIV-infected participants at US PEPFAR-supported sites selected to represent the major geographical and ethnic diversity in Nigeria. Eligible samples were (1) stored in an -80° freezer; (2) collected from consenting patients (>15 years) naïve to antiretroviral therapy with CD4+ count less than 200 cells/mm3. Results A total of 2,752 stored blood samples were retrospectively screened for CrAg. A majority of samples were from participants aged 30 - 44 (57.6%), and 1,570 (57.1%) were from women. The prevalence of CrAg positivity in specimens with CD4 < 200 cells/mm3 was 2.3% (95% CI = 1.8%-3.0%), and varied significantly across the four regions (p < 0.001). At 4.4% (3.2%-5.9%), the South East contained the highest prevalence. Conclusion The significant regional variation in CrAg prevalence found in Nigeria should be taken into consideration as plans are made to integrate routine screening into clinical care for HIV-infected patients.
Background Erythropoietin(EPO) response to anaemia has been reported to be suboptimal in HIV infected anaemic patients. Objectives To assess the relationship between EPO levels and degree of anaemia, CD4+ cell count and viral load of HIV infected treatment naive subjects and if there is any association with inflammatory cytokines. Subjects and Methods A total of 120 subjects aged 18-66 years, comprises (1) HIV infected treatment naive subjects who had anaemia with Hb level <10g/dL. Control subjects were: (2) HIV infected non-anaemic, (3) non-HIV infected anaemic and (4) non-HIV infected non-anaemic individuals. Full blood count using automated counter; CD4+ cell count by semi-automated flow cytometer; and viral load were estimated. Serum erythropoietin levels, serum ferritin levels, CRP levels, TNF-α levels and IL-6 levels were estimated. Appropriateness of EPO response was determined by calculating EPO response ratio. Results Majority (72%) of the HIV infected anaemic patients had a normocytic hypochromic type of anaemia. A weak positive correlation between EPO levels and CD4+ cell count (r=0.075, p=0.572) was obtained. A significant negative correlation between EPO levels and haemoglobin levels (r=-0.268, p=0.003). Twenty-seven (71.05%) of the 38 HIV infected anaemic subjects had EPO response ratio less than 0.8. Serum ferritin level was significantly higher in HIV infected anaemic subjects compared to the controls (p=0.000). Serum interleukin-6 level was significantly higher in HIV infected anaemic subjects compared to HIV infected non-anaemic subjects (p=0.003). Serum C-reactive protein level was significantly higher in HIV infected anaemic subjects compared to non-HIV infected non-anaemic (p=0.004) and non-HIV infected anaemic subjects and(0.001). Serum tumour necrosis factor-α level was significantly higher in HIV infected anaemic subjects compared to other arms of the study population (p=0.000). Conclusion The present study revealed that HIV infected anaemic subjects had reduced serum EPO levels. However, serum inflammatory cytokines levels were raised in the same subjects. Disclosures: No relevant conflicts of interest to declare.
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