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

Abstract

BackgroundCryptococcal 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.MethodsWe 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.ResultsOf 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%.ConclusionWe 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.

Cryptococcal antigenemia and associated risk factors among ART‐naïve and ART‐experienced HIV‐infected peoples at selected health institutions of Mekelle, Northern Ethiopia

“…The prevalence of cryptococcal antigenemia in the current study is relatively higher than the prevalence reported from Adama (1.6%) (Reepalu et al, ) and much lower than the findings from Addis Ababa (8.4%) (Alemu et al, ) and Adama (10.2%) (Beyene et al, ). The difference in the prevalence rate might be due to improvements in a time of ART initiation for HIV‐infected peoples, which might reduce the incidence and high mortality associated with cryptococcal meningitis and other opportunistic infections (Alemu et al, ).…”

“…However, in Ethiopia, a few ART clinics have started CrAg screening procedures. Generating evidence through research will support the existing prevention and control programs (Beyene, Woldeamanuel, Asrat, Ayana, & Boulware, ; Reepalu et al, ). In Ethiopia, the mortality rate due to cryptococcal meningitis is high (Berhe, Melkamu, & Amare, ).…”

A Cross-Sectional Study of Cryptococcal Antigenemia in Anti-Retroviral Naive Hiv Infected Patients

“…12 An overall prevalence of 15% of cryptococcal antigenemia was observed in our study. Studies from Nigeria (12.7%), 13 Ethiopia (14.2%), 14 Congo (15.2%), 15 Bangkok (12.9%) 16 and Uganda (19%) 17 revealed the prevalence of cryptococcal antigenemia was similar to our study. A recent study from South India documented 88.7% of patients with cryptococcal meningitis had HIV infection.…”

Epidemiology of Meningitis in an HIV-Infected Ugandan Cohort

“…9,10 In Ethiopia, the most common neurologic manifestation has been thought to be cerebral toxoplasmosis, followed by TBM and Cryptococcus, 11 although recent studies suggest a very large burden of cryptococcosis among those with advanced HIV. 12,13 Unfortunately, in many African countries, outside of a research setting, microbiological diagnoses of meningitis are difficult to ascertain, and patients are treated empiricallyoften initially with antibacterial agents per WHO guidance. 2 Even in the setting of well-resourced research studies, microbiological meningitis diagnoses are made in a minority of cases.…”