Cryptococcal antigenemia and associated risk factors among ART-naïve and ART-experienced HIV-infected peoples at selected health institutions of Mekelle, Northern Ethiopia

Abstract

Cryptococcal infection is a major cause of opportunistic infection in HIV/AID-infected peoples. We determined cryptococcal antigenemia and cryptococcal meningitis among antiretroviral therapy (ART) initiated and ART-naive HIV-infected peoples. A cross-sectional study was conducted at selected health facilities in Mekelle, Ethiopia. Blood was collected to determine CD4 and plasma cryptococcal antigen (CrAg). CSF CrAg and CSF culture and urease tests were also done. Socio-demographic and clinical data were collected using a structured questionnaire and clinical chart review. From the enrolled study participants, 267 study participants had complete data, of which, 137 (51%) were females. From the study participants, 140 (52%) and 127 (48%) were ART experienced and ART naïve, respectively. The prevalence of cryptococcal antigenemia was 9 (3.4%). All the study participants, except one (CD4 = 120 cells/mm³ ), had CD4 count less than 100 cells/mm³ . From CrAg-positive peoples, 6 (4.7%) were ART naïve. Five CrAg-positive peoples had cryptococcal meningitis. Being male, rural residence, and being hospitalized were associated with cryptococcal antigenemia. Cryptococcal infection poses a substantial risk of HIV-positive peoples. This study provides relevant data for CrAg screening interventions in patients with low CD4 cell counts.

Keywords: ART-experienced; ART-naive; HIV infected; Mekelle; cryptococcal antigenemia.

Figure 1

Study participant recruitment flowchart: ^¶ART: antiretroviral therapy; *CA: cryptococcal antigenemia; ^$CM: cryptococcal meningitis; ^#CSF: cerebrospinal fluid; ^¥LFA CrAg: lateral flow assay cryptococcal antigen