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

Hailu, K; Niguse, Selam; Hagos, Kiflom; Abdulkader, Mahmud

doi:10.1002/mbo3.746

Cited by 9 publications

(9 citation statements)

References 30 publications

(66 reference statements)

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“…Although the WHO recommends the CrAg test as a part of the routine screening among HIV patients, data on the burden of cryptococcal disease in Ethiopia are quite limited. Finding in the present study on the overall prevalence of positive serum CrAg has shown to be lower as compared with that of domestic studies including 10.2% in Adama [ 28 ], 8.3% in Gondar [ 34 ], 8.5% in Addis Ababa [ 26 ], while somewhat parallel with a recent finding from Mekelle which was 3.4% but higher than a 1.6% report from Adama [ 35 , 36 ]. Apparently, the cryptococcal magnitude in Ethiopia has shown variability from time to time which might be an indicator in the consistency and efficacy of early ART initiation and adherence among HIV infected individuals as well as the introduction of antifungal therapy.…”

Section: Discussionsupporting

confidence: 67%

Opportunistic Cryptococcal Antigenemia in the HAART Era at HIV Epidemic Settings of Northwest Ethiopia

Negash

Wondmagegn

Tajebe

2020

Canadian Journal of Infectious Diseases and Medical Microbiolog

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Background. Cryptococcus neoformans is a frequent opportunistic infection in patients with the acquired immunodeﬁciency syndrome. While the advent of ART reduces the occurrence of cryptococcal meningitis in HIV patients, cryptococcal disease remains a leading cause of morbidity and mortality in the developing world especially in sub-Saharan Africa which is the epicenter of HIV. This study aimed to assess the cryptococcal antigenemia, CD4+ Th cell counts, HIV RNA viral load, and clinical presentations among HIV-positive patients in Northwest Ethiopia. Method. A total of two hundred (200) HIV-positive patients were recruited for this study. Cryptococcus antigenemia prevalence in plasma samples of HIV‐positive patients was determined by using Antigen lateral ﬂow assay (CrAg‐LFA) also, and CD4+ Th cell counts and HIV‐RNA levels were quantified from blood specimen. Patients’ demographic data, clinical manifestation, and concurrent opportunistic infection were recorded. Result. The sex distributions of study participants were 105(52.5%) male and 94(47.5%) female with an age range of 15–65 (mean 39.42 ± 9) years. All patients had a CD4+ T-cell count <100 cells/µl with the median 54 cells/μl and median HIV-RNA viral load 2.16 × 105 RNA copies/ml (50–3.66 × 105 RNA copies/ml); the prevalence of cryptococcal antigenemia was found to be 4% in HIV-positive patients. More than half and two third of CrAg‐positive patients had a CD4 count <25 cells/μl and HIV viral load >10,000 copies/ml, respectively, as well; Tuberculosis, Candidiasis, and herpes zoster are the most often observed concurrent infections while cryptococcal antigenemia is significantly associated with oral candidiasis (p<0.001). Conclusion. Although the advent of ART, early diagnosis of cryptococcosis, and application of antifungal interventions, HIV-induced cryptococcal antigenemia positivity in HIV infected individuals is still the countries’ big challenge. Thus, stringent follow-up and case management should be considered.

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Section: Discussionsupporting

confidence: 67%

Opportunistic Cryptococcal Antigenemia in the HAART Era at HIV Epidemic Settings of Northwest Ethiopia

Negash

Wondmagegn

Tajebe

2020

Canadian Journal of Infectious Diseases and Medical Microbiolog

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“…In this review, data of 8,338 HIV positive individuals (male gender 25%-76.3% and median age range 30-40 years) were included. [36] 2017 Ethiopia 2016-7 CS Letang et al [37] 2015 Tanzania 2008-12 Cohort Christopher et al [38] 2015 Nigeria 2010-11 CS Williams et al [39] 2015 Uganda 2013-14 CS Alemu et al [40] 2013 Ethiopia 2011 CS Derbie et al [41] 2018 Ethiopia 2016 CS Mamuye et al [42] 2016 Ethiopia 2013-14 CS Oyella et al [43] 2012 Uganda 2009-10 CS Ogouyemi et al [18] 2016 Benin 2015 CS Drain et al [44] 2015 S. Africa 2011-13 CS Mdodo et al [45] 2010 Kenya 2008-9 CS Micol et al [30] 2007 Cambodia 2004 CS Jarvis et al [46] 2009 South Africa 2002-5 CS Wajanga et al [47] 2011 Tanzania 2009-10 Cohort Magambo et al [48] 2014 Tanzania 2012-13 CS *CS: Cross-sectional study design.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The figure is excluded from the pooled prevalence analysis. No data Ganiem et al [29] No data Cheryl et al [31] No data Beyene et al [32] Being ART naive and ART-defaulter Meya et al [33] A cryptococcal diagnosis during follow-up Rugemalila et al [34] No data Longley et al [35] No data Hailu et al [36] Being male, living in rural areas, being hospitalized Letang et al [37] No data Christopher et al [38] Female gender, CD4 count of <200 cell/μL Williams et al [39] No data Alemu et al [40] An increasing age, self-reported fever, CD4 count <100 cells and site of screening. Derbie et al [41] Gender Mamuye et al [42] Lower median CD4, history of cryptococcal disease, having symptoms of headache, Oyella et al [43] Low body mass index, CD4+ count of less than 50 cells/mm3, recent diagnosis of H meningeal signs Ogouyemi et al [18] Body mass index<18.5kg/m2, an alteration of the general condition with a CD4 lym counts<50cells/μL Drain et al [44] CD4 counts < 50 cells/μL Mdodo et al [45] male sex, headache, blurred vision and previous antifungal drug use Micol et al [30] Countryside residence, headache, body mass index <15.4 kg/m2, CD4+ count <50 gender Jarvis et al [46] Baseline CD4 cell count, incident cryptococcal meningitis, history of cryptococcal di Wajanga et al [47] CD4 counts of < 100 cells, altered mental status, neck stiffness, fever Magambo et al [48] Age, body mass index, CD4 count and WHO stage…”

Section: Predictors Of Cryptococcal Antigenemiamentioning

confidence: 99%

Cryptococcal antigenemia and its predictors among HIV infected patients in resource limited settings: a systematic review

Derbie

Mekonnen

Woldeamanuel

et al. 2020

Preprint

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Background: Cryptococcosis is an opportunistic fungal infection that primarily affects people with advanced HIV/AIDS and is an important cause of morbidity and mortality around the globe. By far the most common presentation of the disease is cryptococcal meningitis (CM), which leads to an estimated 15-20% of all HIV related deaths worldwide, 75% of which are in sub-Saharan Africa. However, to the best of our knowledge there is quite limited reviewed data that on the epidemiology of cryptococcal antigenemia in a large HIV-infected population in resource limited settings. Methods: Articles published in English irrespective of the time of publication were systematically searched using comprehensive search strings from PubMed/Medline and SCOPUS. In addition, Google Scholar and Google databases were searched manually for grey literature. Two reviewers independently assessed study eligibility, extracted data, and assessed risk of bias. The magnitude of cryptococcal antigenemia and its predictors were presented with descriptive statistics and summary measures. The pooled prevalence of cryptococcal antigenemia was also determined with 95% confidence interval (CI). Result: Among 2941 potential citations, we have included 22 studies with a total of 8,338 HIV positive individuals. The studies were reported in ten different countries during the year (2007-2018). Most of the articles reported the mean CD4 count of the participants <100 cells/µl. The pooled prevalence of cryptococcal antigenemia at different CD4 count and ART status was at 8% (95%CI: 6-10%) (ranged between 1.7% and 33%). Body mass index (BMI) <18.5kg/m2, CD4 count <100 cells, presenting with headache and male gender were reported by two or more articles as an important predictors of cryptococcal antigenemia. Conclusions: Implementing a targeted screening of HIV patients with low BMI, CD4 count <100 cells, having headache and males; and treatment for asymptomatic cryptococcal disease should be considered. Additional data is needed to better define the epidemiology of cryptococcal antigenemia and its predictors in resource limited settings in order to design prevention, diagnosis, and treatment strategies.

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“…Hence, we considered all as good quality articles. Ganiem et al [29] Cheryl et al [31] Beyene et al [32] Meya et al [33] Rugemalila et al [34] Longley et al [35] Hailu et al [36] Letang et al [37] Christopher et al [38] Williams et al [39] Alemu et al [40] Derbie et al [41] Mamuye et al [42] Oyella et al [43] Ogouyemi et al [18] Drain et al [44] Mdodo et al [45] Micol et al [30] Jarvis et al [46] Wajanga et al [47] Magambo et al [48] The tables showed that the overall score ranged 5-7 which is > 50%.…”

Section: Risk Of Biasmentioning

confidence: 99%

Section: Predictors Of Cryptococcal Antigenemiamentioning

confidence: 99%

Cryptococcal antigenemia and its predictors among HIV infected patients in resource limited settings: a systematic review

Derbie

Mekonnen

Woldeamanuel

et al. 2019

Preprint

View full text Add to dashboard Cite

Background : Cryptococcosis is an opportunistic fungal infection that primarily affects people with advanced Human immunodeficiency virus (HIV) disease and is an important cause of morbidity and mortality around the globe. By far the most common presentation of the disease is cryptococcal meningitis (CM), which leads to an estimated 15-20% of all HIV related deaths worldwide, 3/4 of which are in sub-Saharan Africa. However, to the best of our knowledge there is quite limited reviewed data that on the epidemiology of cryptococcal antigenemia in a large HIV-infected population in resource limited settings. Methods : Articles published in English irrespective of the time of publication were systematically searched using comprehensive search strings from PubMed/Medline and SCOPUS. In addition, Google Scholar and Google databases were searched manually for grey literature. Two reviewers independently assessed study eligibility, extracted data, and assessed risk of bias. The magnitude of cryptococcal antigenemia and its predictors were presented with descriptive statistics and summary measures. The pooled prevalence of cryptococcal antigenemia was also determined with 95% confidence interval (CI). Result: A mong 2941 potential citations, we have included 22 studies with a total of 8,338 HIV positive individuals. The studies were reported in ten different countries during the year (2007-2018). Most of the articles reported the mean CD4 count of the participants <100 cells/µl. The pooled prevalence of cryptococcal antigenemia at different CD4 count and ART status was at 8% (95%CI: 6-10%) (ranged between 1.7% and 33%). Body mass index (BMI) <18.5kg/m 2 , CD4 count <100 cells, presenting with headache and male gender were reported by two or more articles as an important predictors of cryptococcal antigenemia. Conclusions : Implementing a targeted screening of HIV patients with low BMI, CD4 count <100 cells, having headache and males; and treatment for asymptomatic cryptococcal disease should be considered. Additional data is needed to better define the epidemiology of cryptococcal antigenemia and its predictors in resource limited settings in order to design prevention, diagnosis, and treatment strategies.

show abstract

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

Cited by 9 publications

References 30 publications

Opportunistic Cryptococcal Antigenemia in the HAART Era at HIV Epidemic Settings of Northwest Ethiopia

Opportunistic Cryptococcal Antigenemia in the HAART Era at HIV Epidemic Settings of Northwest Ethiopia

Cryptococcal antigenemia and its predictors among HIV infected patients in resource limited settings: a systematic review

Cryptococcal antigenemia and its predictors among HIV infected patients in resource limited settings: a systematic review

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