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

Abstract

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 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 pooled prevalence of cryptococcal antigenemia was determined with 95% confidence interval (CI). Results: Among 2941 potential citations, we have included 22 studies with a total of 8338 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 below 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) < 18.5 kg/m 2 , CD4 count < 100 cells, patients 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 optimize the prevention, diagnosis, and treatment strategies.

Prevalence of cryptococcal meningitis among people living with human immuno-deficiency virus and predictors of mortality in adults on induction therapy in Africa: A systematic review and meta-analysis

“…This implies that the overall CM prevalence among PLWH in the study could have been much lower or even closer to our African estimate. A systematic review by Derbie et al found the prevalence of cryptococcal antigenemia to be 8% (95% CI 6–10) which was almost double our prevalence for CM which was logical since not all cases of cryptococcal antigenemia result in invasive cryptococcal disease ( 55 ). Although cryptococcal antigenemia is not equivalent to a diagnosis of CM, it has been thought of as an important proxy measure for CM in PLWH ( 60 ).…”

“…However, culture has drawbacks which include being more expensive and delaying diagnosis by 3–7 days ( 54 ). The use of serum cryptococcal antigen (CRAG) testing is indicated as a screening method for likely CM in advanced HIV and is only used to commence prophylactic therapy among CRAG-positive individuals ( 14 , 55 ).…”

Cryptococcal antigen carriage among HIV infected children aged 6 months to 15 years at Laquintinie Hospital in Douala

“…in his pediatric cohort population study carried out in China in 2017, found that 19 children (35.8%) had history of exposure to poultry including 11 children exposed to pigeons and 8 exposed to chickens [ 14 ]. Numerous other studies have suggested that Cryptococcus neoformans is found worldwide in association with the feces of certain birds such as pigeons [ 19 , 20 ].…”

Predictors of AIDS-related death among adult HIV-infected inpatients in Kisangani, the Democratic Republic of Congo

“…Previous studies in Nigeria [ 19 ], Ghana [ 20 ], Benin [ 21 ], Burkina Faso [ 21 ], Cote d'Ivoire [ 21 ], Mali [ 21 ], Senegal [ 21 ], and Sierra Leone [ 22 ] have similarly reported an AIDS-related death rate of around 30% among hospitalized patients, as in our study. Opportunistic infections are reported in Africa as the leading cause of hospitalization for AIDS-related deaths [ 12 , 23 , 24 ]. Similar findings were observed in our series.…”