Screening for Cryptococcal Antigenemia and Burden of Cryptococcosis at the Time of HIV Diagnosis: A Retrospective Multicenter Study

Abstract

Introduction: Screening for cryptococcal antigen (CrAg) is recommended for people living with HIV (PLWH) who present with low CD4 lymphocyte counts. Real-world experience is important to identify gaps between the guidelines and clinical practice. We investigated the trends of CrAg testing and prevalence of cryptococcal antigenemia among PLWH at the time of HIV diagnosis and the related mortality in Taiwan from 2009 to 2018. Methods: Medical records of newly diagnosed PLWH seeking care at six medical centers around Taiwan between 2009 and 2018 were reviewed. The annual trends of PLWH who had CrAg testing and cryptococcal antigenemia were examined by Cochran-Armitage test. Among PLWH with CD4 \ 200 cells/ll, timing of CrAg testing was analyzed for association with 12-month all-cause mortality in Kaplan-Yuan-Ti Lee, Chien-Ching Hung have contributed equally to the work and should be considered joint senior authors.The members of the Taiwan HIV Study Group are mentioned in the ''Acknowledgements'' section.

Impaired centrosome biogenesis in kidney stromal progenitors reduces abundance of interstitial lineages and accelerates injury-induced fibrosis

“…In contrast, there was no significant difference in the fraction of cells in G0/G1 (Aldh1a2+/EdU-/pHH3-) or S-phase (Aldh1a2+/EdU+) between groups (Figures 4E and 4F). These data suggest that centrosome loss in stromal progenitors results in delayed transition through G2/M, consistent with previous reports showing mitotic delay upon defective centrosome biogenesis 16,21,48 .…”

“…It has recently been shown that centrosome loss and prolonged mitosis leads to p53dependent cell cycle arrest, induction of the mitotic surveillance mechanism, and activation of caspase-dependent cell death 16,21,22,48,49 . We wondered if the observed G2/M-phase delay in Cep120-KO kidneys similarly results in p53 activation and increased apoptosis of stromal progenitors and derived cells.…”

The incidences and clinical outcomes of cryptococcosis in Taiwan: A nationwide, population-based study, 2002–2015

“…This time trend was similar to that in a previous study using a state inpatient database in the US, which showed that the number of CM hospitalizations decreased 5.8% annually among PLWH from 1997 to 2009. 7 Nevertheless, a multicenter study in Taiwan reported that the prevalence of cryptococcal antigenemia (7.8%) among newly diagnosed PLWH with low cluster of differentiation 4 (CD4) cell counts remained stable over ten years, 25 which was comparable with the estimated global prevalence of cryptococcal antigenemia (6%) among PLWH with a CD4 count < 100 cell/µl. 4 These data suggested that cryptococcosis screening and preventive measures for PLWH remain important and should focus on these late presenters.…”

Immune Reconstitution Inflammatory Syndrome in People Living with HIV Who Presented with Interstitial Pneumonitis: an Emerging Challenge in the Era of Rapid Initiation of Antiretroviral Therapy

“…These ART regimens included tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC)/efavirenz and TDF/FTC/rilpivirine, abacavir/lamivudine/dolutegravir in 2016; tenofovir alafenamide (TAF)/FTC/rilpivirine and TAF/FTC/elvitegravir/cobicistat in 2018; and TAF/FTC/bictegravir and lamivudine/dolutegravir in 2019 and 2020, respectively. The national HIV treatment guidelines recommended ART initiation within 7 days of a confirmed HIV diagnosis in 2018 and same-day ART initiation in 2021 ( 40 , 41 ). Testing for CD4 and PVL are performed at baseline, at 1 month of ART initiation, subsequently every 3 months within the first year of ART initiation, and every 3 to 6 months after the PLWH have achieved viral suppression on stable ART.…”