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. 2015 Nov;16(10):640-4.
doi: 10.1111/hiv.12263. Epub 2015 May 11.

Prevalence of cryptococcal antigenuria at initial HIV diagnosis in KwaZulu-Natal

P K Drain  1 , J M Kleene  2 , S M Coleman  3 , E Losina  1   4 , J N Katz  5 , J Giddy  6 , D Ross  7 , K A Freedberg  1   4 , I V Bassett  1
Affiliations

Prevalence of cryptococcal antigenuria at initial HIV diagnosis in KwaZulu-Natal

P K Drain et al. HIV Med. 2015 Nov.

Abstract

Objectives: The World Health Organization (WHO) recommends screening HIV-infected people for cryptococcal antigens to identify cryptococcosis, a major cause of AIDS-related deaths. As the burden of cryptococcosis is unknown in South Africa's KwaZulu-Natal province, we assessed the cryptococcal antigenuria prevalence among newly diagnosed HIV-infected adults there.

Methods: We conducted a cross-sectional study of newly diagnosed HIV-infected adults who received voluntary HIV testing in an out-patient clinic. Participants provided a urine specimen in a sterile container, and we performed testing with a WHO-endorsed rapid cryptococcal antigen lateral flow assay (Immy Inc., Norman, OK, USA) per the manufacturer's specifications. We assessed cryptococcal antigenuria prevalence among participants with CD4 counts < 200 cells/μL, and stratified results by CD4 count categories.

Results: Among 432 participants, the mean (± standard deviation) age was 36.1 ± 9.9 years and 172 (40%) were female. The overall estimated prevalence of cryptococcal antigenuria was 9.0% [95% confidence interval (CI) 6.5-12.1%]. CD4 counts were available for 319 participants (74%); the median CD4 count was 75 cells/μL [interquartile range (IQR) 34-129 cells/μL]. Participants with a negative cryptococcal antigenuria screening test had a median CD4 count of 79 cells/μL (IQR 36-129 cells/μL), while participants with a positive cryptococcal test had a median CD4 count of 41 cells/μL (IQR 10-112 cells/μL). The estimated prevalence of cryptococcal antigenuria among participants with CD4 counts < 50 cells/μL was 12.5% (95% CI 7.0-20.1%), which was significantly higher than that among participants with CD4 counts of 50-200 cells/μL (4.8%; 95% CI 2.3-8.7%).

Conclusions: Nearly 1 in 10 newly diagnosed HIV-infected adults with CD4 counts < 200 cells/μL in KwaZulu-Natal had evidence of cryptococcal antigenuria. Point-of-care CD4 count testing and cryptococcal antigen screening may rapidly identify cryptococcosis at the time of HIV diagnosis.

Keywords: CD4 count; HIV/AIDS; South Africa; cryptococcal urine antigen; cryptococcosis; cryptococcus; diagnosis.

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References

    1. Park BJ, Wannamueler KA, Marston BJ. Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS. AIDS 2009; 23: 525–530. - PubMed
    1. World Health Organization . Rapid Advice: Diagnosis, Prevention and Management of Cryptococcal Disease in HIV‐Infected Adults, Adolescents and Children. Geneva, WHO, 2011. - PubMed
    1. Jarvis JN, Percival A, Bauman S et al Evaluation of a novel point‐of‐care cryptococcal antigen test on serum, plasma, and urine from patients with HIV‐associated cryptococcal meningitis. Clin Infect Dis 2011; 53: 1019–1023. - PMC - PubMed
    1. Jarvis JN, Lawn SD, Vogt M, Bangani N, Wood R, Harrison TS. Screening for cryptococcal antigenemia in patients accessing an antiretroviral treatment clinic in South Africa. Clin Infect Dis 2009; 48: 856–862. - PMC - PubMed
    1. Liechty CA, Solberg P, Were W et al Asymptomatic serum cryptococcal antigenemia and early mortality during antiretroviral therapy in rural Uganda. Trop Med Int Health 2007; 12: 929–935. - PubMed

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