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. 2013 Apr;18(4):495-503.
doi: 10.1111/tmi.12067. Epub 2013 Feb 1.

The impact of routine cryptococcal antigen screening on survival among HIV-infected individuals with advanced immunosuppression in Kenya

A-C L Meyer  1 , C K Kendi, J A Penner, N Odhiambo, B Otieno, E Omondi, E Opiyo, E A Bukusi, C R Cohen
Affiliations

The impact of routine cryptococcal antigen screening on survival among HIV-infected individuals with advanced immunosuppression in Kenya

A-C L Meyer et al. Trop Med Int Health. 2013 Apr.

Abstract

Objectives: To test the hypothesis that a screening and treatment intervention for early cryptococcal infection would improve survival among HIV-infected individuals with low CD4 cell counts.

Methods: Newly enrolled patients at Family AIDS Care and Education Services (FACES) in Kenya with CD4 ≤ 100 cells/μl were tested for serum cryptococcal antigen (sCrAg). Individuals with sCrAg titre ≥ 1:2 were treated with high-dose fluconazole. Cox proportional hazard models of Kaplan-Meier curves were used to compare survival among individuals with CD4 ≤ 100 cells/μl in the intervention and historical control groups.

Results: The median age was 34 years [IQR: 29,41], 54% were female, and median CD4 was 43 cells/μl [IQR: 18,71]. Follow-up time was 1224 person-years. In the intervention group, 66% (514/782) were tested for sCrAg; of whom, 11% (59/514) were sCrAg positive. Mortality was 25% (196/782) in the intervention group and 25% (191/771) in the control group. There was no significant difference between the intervention and control group in overall survival [hazard ratio (HR): 1.1 (95%CI:0.9,1.3)] or three-month survival [HR: 1.0 (95%CI:0.8,1.3)]. Within the intervention group, sCrAg-positive individuals had significantly lower survival rates than sCrAg-negative individuals [HR:1.8 (95%CI: 1.0, 3.0)].

Conclusions: A screening and treatment intervention to identify sCrAg-positive individuals and treat them with high-dose fluconazole did not significantly improve overall survival among HIV-infected individuals with CD4 counts ≤ 100 cells/μl compared to a historical control, perhaps due to intervention uptake rates or poor efficacy of high-dose oral fluconazole.

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Conflict of interest statement

Declarations of Interest: Dr. Meyer has received honoraria from Abbott and a drug donation from Valeant Pharmaceuticals., Ms. Kendi has no conflicts of interest to disclose., Dr. Penner has no conflicts of interest to disclose., Mr. Odhiambo has no conflicts of interest to disclose., Mr. Otieno has no conflicts of interest to disclose., Dr. Bukusi has no conflicts of interest to disclose., Dr. Cohen has no conflicts of interest to disclose

Figures

Figure 1
Figure 1
Flow chart describing eligibility and outcomes of HIV infected individuals newly enrolling in care and treatment at Family AIDS Care and Education Services in Kenya in 2009-2010.
Figure 2
Figure 2
Kaplan-Meier survival curves for overall survival in the control and intervention groups in an evaluation of a screening and treatment intervention for early cryptococcal infection in Kenya in 2009-2010.
Figure 3
Figure 3
Kaplan-Meier survival curves for overall survival in serum cryptococcal antigen (sCrAg) positive and negative individuals identified as part of a screening and treatment intervention for early cryptococcal infection in Kenya in 2009-2010
See this image and copyright information in PMC

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