Prevalence of cryptococcal antigen (CrAg) among HIV-positive patients in Eswatini, 2014–2015

Abstract

Background Cryptococcal meningitis is a leading cause of death amongst people living with HIV. However, routine cryptococcal antigen (CrAg) screening was not in the national guidelines in Eswatini. Objectives A cross-sectional study was conducted between August 2014 and March 2015 to examine CrAg prevalence at Mbabane Government Hospital in Eswatini. Methods We collected urine and whole blood from antiretroviral-therapy-naïve patients with HIV and a cluster of differentiation 4 (CD4) counts < 200 cells/mm 3 for plasma and urine CrAg lateral flow assay (LFA) screening at the national HIV reference laboratory. Two CD4 cut-off points were used to estimate CrAg prevalence: CD4 < 100 and < 200 cells/mm 3 . Sensitivity and specificity of urine CrAg LFA was compared to plasma CrAg LFA. Results Plasma CrAg prevalence was 4% (8/182, 95% confidence interval [CI]: 2–8) amongst patients with CD4 counts of < 200 cells/mm 3 , and 8% (8/102, 95% CI: 3–15) amongst patients with CD4 counts of < 100 cells/mm 3 . Urine CrAg LFA had a sensitivity of 100% (95% CI: 59–100) and a specificity of 80% (95% CI: 72–86) compared with plasma CrAg LFA tests for patients with CD4 < 200 cells/mm 3 . Forty-three per cent of 99 patients with CD4 < 100 were at World Health Organization clinical stages I or II. Conclusion The prevalence of CrAg in Eswatini was higher than the current global estimate of 6% amongst HIV-positive people with CD4 < 100 cell/mm 3 , indicating the importance of initiating a national screening programme. Mechanisms for CrAg testing, training, reporting, and drug and commodity supply issues are important considerations before national implementation.

Same Day Antiretroviral Therapy Initiation, Prevalence and Co-factors of Advanced HIV Disease in an African Population- A 1 Year Report

“…Cryptococcal disease is one of the most important opportunistic infection among people living with advanced HIV disease and Sub-Saharan Africa share three quarter of the burden [29]. A positive CrAg test was observed in 18 (9.2%) of 196 patients who were tested for cryptococcal infection which though higher than the global prevalence of 6% [30] is similar to reports from other African studies [30,31].…”

African laboratory medicine in the time of COVID-19

“…Volume 9, Issue 1 of AJLM goes beyond chronicling a broad range of infectious disease catastrophes to outlining lessons learned that will strengthen health systems. 3 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 While most pandemic activity has focused on reverse transcription polymerase chain reaction and other forms of testing to support the identification of cases and transmission chains, 10 other domains of laboratory medicine have made important contributions that shed more light on the pathogenesis of the disease, and therefore how best to improve treatment. 19 , 20 …”

“…Volume 9, Issue 1 of AJLM goes beyond chronicling a broad range of infectious disease catastrophes to outlining lessons learned that will strengthen health systems. 3,9,10,11,12,13,14,15,16,17,18 While most pandemic activity has focused on reverse transcription polymerase chain reaction and other forms of testing to support the identification of cases and transmission chains, 10 other…”