Prevalence of Cryptococcal Antigen and Outcomes in People With Human Immunodeficiency Virus in Honduras: A Cohort Study

Abstract

Background Cryptococcal meningitis is a major cause of death among people living with HIV (PLWH). Cryptococcal antigen (CrAg) testing of asymptomatic patients is an important public health measure to reduce mortality in high incidence areas. However, limited data exists on CrAg prevalence in Central America. Methods We conducted a prospective cohort study at the two largest HIV clinics and hospitals in Honduras. CrAg in serum and cerebrospinal fluid was performed in individuals living with HIV who had CD4 ≤ 100 cells/mm 3 between 2017-2018. After CrAg testing, individuals were followed up for 12 months to assess mortality using adjusted cox proportional hazard models. Results A total of 220 PLWH were tested for CrAg of which 12.7% (n=28) tested positive. CrAg prevalence was higher among hospitalized individuals in 40% (n=10 of 25) of the cases. The proportion (35.8%) of individuals taking ART was significantly (p<0.01) lower among those who tested positive for CrAg. Overall mortality among the cohort was 11.4% (n=25 of 220) by 12 months. CrAg-positive cases were at a significantly higher risk of death [aHR: 2.69, 95%: 1.07-6.84] when compared to CrAg-negative participants. Conclusions CrAg prevalence in Honduras was high among PLWH. Moreover, individuals who tested positive for CrAg testing were at a higher risk of death. Systemic CrAg of PLWH with a CD4 ≤ 100 cells/mm 3 should be routinely performed in Central America.

Epidemiology and Mortality of Cryptococcal Disease in Guatemala: Two-Year Results of a Cryptococcal Antigen Screening Program

“…For more information about the reporting criteria in each country, see Supplementary Data (Supplementary Material) . Considering all regional publications, four reported the frequency of CrAg in patients with ≤100 cells/mm 3 [ 9 , 10 , 11 , 12 ] and three in patients with <200 cells/mm 3 [ 9 , 13 , 14 ]. Using these results and ours, the estimated overall CrAg frequency in the region for PLWHIV with <100 CD4 cells/mm 3 was 9.2% (IC95% 7.9–10.7%) and 8.1% in those with AHD (IC95% 7.9–10.7%).…”

“…Among Latin American people with HIV, we estimated that CrAg positivity is 9.2% (IC95% 7.9–10.7%) in patients with <100 CD4/mm 3 [ 9 , 10 , 11 , 12 , 13 , 14 ]. This number is 3.2% higher than the global estimation by Rajasingham et al in asymptomatic patients [ 2 ], which is an uncertain denomination considering the deep immunosuppressed status of such HIV patients.…”

“…This number is 3.2% higher than the global estimation by Rajasingham et al in asymptomatic patients [ 2 ], which is an uncertain denomination considering the deep immunosuppressed status of such HIV patients. In published articles from Brazil, Argentina and Honduras, the criteria to establish the burden of cryptococcal disease were similar, with CD4 thresholds of <100 or <200 cells/mm 3 [ 10 , 11 , 13 ]. However, in Guatemala, we screened patients regardless of the CD4 cell count, symptoms, or hospitalized status, with an overall incidence of 4.8% ( Table 2 ), which is a real measurement of the burden of disease in PLWHIV.…”

Burden of serious fungal infections in Honduras

“…The overall prevalence was of 12.7% and was 40% among hospitalised patients. The 12‐month mortality rate was 11.4% 37 . Based on information from this recent study, approximately 452 cases and 52 deaths per year are assumed to occur in PLHIV at risk for OIs assuming that 66% of the PLHIV population at risk for OIs had a CD4 of <100 cells/mm 3 .…”

“…The 12-month mortality rate was 11.4%. 37 Based on information from this recent study, approximately 452 cases and 52…”