Cryptococcal antigenemia among HIV seropositive patients accessing care in antiretroviral therapy (ART) clinics in Calabar, South Southern Nigeria

Abstract

Background: Cryptococcus neoformans infection is a life threatening disease especially when associated with immunosupression like HIV/AIDS. The greatest burden of disease occurs in sub-Saharan Africa, where mortality is estimated to be 17%. The finding of cryptococcal antigen in the blood represents a condition of systemic invasion with the fungus. Clinical manifestation of infection with Cryptococcus neoformans in AIDS patients is generally more evident at CD4 cells ≤100 cells/µl. This study was carried out to determine cryptococcal antigenemia among HIV seropositive patients accessing care in ART clinics as patients are not screened routinely despite reports of relatively high co-infection rates with HIV. Methods: This prospective cross-sectional study was carried out on ART-treated and ART-naive HIV positive adult patients attending ART clinics in two tertiary hospitals in Calabar, Nigeria. The seroprevalence of cryptococcal antigen among the patients was determined using the cryptococcal antigen latex agglutination system (CALAS) (Wampole Laboratories, USA), according to the manufacturer's instruction. The CD4 count levels of each patient were determined by flow cytometry using the fluorescent activated cell sorter BD FACS Count system (Becton Dickinson). Results: Out of the 272 HIV positive subjects enrolled in the study, 116(42.6%) were ARV-naïve and 156(57.4%) were ARV-treated patients. A 5.1% cryptococcal antigenemia prevalence was established in the study. Infection rates were higher among subjects receiving ART 11/156 (7.1%) than in ARTnaïve subjects 3/116 (2.6%). Infection rates 5(35.7%) peaked at age 25-34 years. The mean CD4 counts of subjects with cryptococcal infection were 100.7±67.8 cells/µl, with a minimum CD4 count of 13.0. All the infections occurred among subjects with CD4 counts ≤200 cells/µl of blood. There was a statistically significant effect of cryptococcal antigenemia on the CD4 counts of the subjects (t=3.7, p=0.002). Conclusion: This study reveals that cryptococcal antigenemia is a health problem among HIV/ AIDS patients in our locality. Cryptococcal antigenaemia seem to be more common among HIV patients on ART. The CD4 count levels among the ART treated subjects could have been boosted by administration of ART

Magnitude of Cryptococcosis among HIV patients in sub-Saharan Africa countries: a systematic review and meta-analysis

“…Based on our inclusions criteriafive articles from Ethiopia 14 , 19 , 20 , 23 , 28 , four from Nigeria 16 , 24 , 27 , 29 , three from Tanzania, 15 , 21 , 26 , two from Uganda 18 , 22 and one from each Cameroon and Malawi 17 , 25 respectively were selected and included for the review and meta-analysis.…”

“…Most of the studies were conducted on adult HIV patients in studies from Uganda 18 , 22 , Malawi 25 , Tanzania 26 , and Nigeria 27 . The rest of the studies were conducted on all HIV patients from Cameroon 17 , Ethiopia 20 and Nigeria 24 ; on Adolescent & adult HIV admitted patientsfrom Tanzania 15 , on ART naïve patients in a study from Nigeria 16 , ≥18 years old HIV patients<200cells/µl CD4 from Ethiopia19, ≥18 years ART naïve patients <200 cells/µl CD4 from Tanzania 21 , ≥18 years ART-naïve 23 , admitted HIV patients from Ethiopia 28 , ART naïve HIV patients from Nigeria 29 .…”

“…Different types of sampleswere used to diagnosis the presence of Cryptococcus infection. None the less, most of the studies were conducted using serum 19 , 20 , 24 , 26 – 29 , both cerebrospinal fluid (CSF)/serum 15 , 16 , 18 , 23 , CSF 14 , urine and serum 21 , CSF, urine & serum 17 , urine 22 and whole blood 25 . More than 50% of the studies used latex agglutinations (LA) laboratory method and the rest of the studies used Lateral flow assay (LFA), both LFA & LA, and two studies used both Indian ink and fungal culture method.…”

“…The highest of Cryptococcosis magnitude were reported from Uganda which was 19.0% in 201218 and the least was from Ethiopia in 2015 which was (1.6%) 23 . The median CD4 count was reported in more than 50% of studies in which the highest was reported from Nigeria that is 101 cells/µl 24 and the lowest count was reported from Tanzania 19 cells/µl 26 .…”

“…A total of 144 related articles were retrieved. After carefully examining the title, uniformity of study design, study subjects, sample sizeand study period,16 articles were selected for systematic review and meta-analysis [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] .…”