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. 2023 Jan 31;3(1):e0001313.
doi: 10.1371/journal.pgph.0001313. eCollection 2023.

A multicenter survey of asymptomatic cryptococcal antigenemia among patients with advanced HIV disease in Nigeria

Rita O Oladele  1   2 , Alexander M Jordan  3 , Joy U Okaa  4 , Iriagbonse I Osaigbovo  5 , Shuwaram A Shettima  6 , Nathan Y Shehu  7 , Adeyinka A Davies  8 , Yahaya Mohammed  9 , Mary A Alex-Wele  10 , Garba Iliyasu  11 , Jude C Nwaokenye  12 , Samuel A Fayemiwo  12 , Ubong A Udoh  13 , Titilola Gbajabiamila  14 , David W Denning  15 , Tom M Chiller  3
Affiliations

A multicenter survey of asymptomatic cryptococcal antigenemia among patients with advanced HIV disease in Nigeria

Rita O Oladele et al. PLOS Glob Public Health. .

Abstract

As of 2018, cryptococcal antigen (CrAg) screening in patients with advanced human immunodeficiency virus (HIV) disease (AHD) was not routinely implemented in Nigeria despite being recommended in the national HIV treatment guidelines. Our aim was to determine the prevalence and risk factors for asymptomatic cryptococcal antigenemia in adult people living with HIV (PLHIV) in Nigeria to advocate for the implementation of routine CrAg screening. A descriptive cross-sectional study and CrAg screening of consecutive adult PLHIV with CD4 counts ≤200 cells/μL was conducted from April 2018 to April 2019 at HIV clinics in eleven tertiary hospitals spread across Nigeria's six geopolitical regions. Prevalence of asymptomatic cryptococcal antigenemia was estimated by facility and geopolitical zone. Logistic regression was conducted to identify risk factors for cryptococcal antigenemia. In total, 1,114 patients with AHD were screened. The overall prevalence of asymptomatic cryptococcal antigenemia was 3.9% with wide variation across facilities (range: 0/75 [0%]- 15/122 [12.3%]) and geopolitical zones (range: 0/75 [0%]-19/279 [6.8%]). Prevalence of antigenemia was highest in the South-West (19/279 [6.8%]) and lowest in the North-East (0/75 [0%]). Prevalence was 5.2% (26/512) and 3.2% (18/561) in patients with CD4<100 and CD4 of 101-200, respectively. Of all patients with antigenemia, 50% were on antiretroviral therapy (ART) at the time of having a positive CrAg test. In adjusted analysis, cryptococcal antigenemia was significantly less in patients on ART and patients who had completed any formal education. The survey showed a high overall burden of cryptococcal antigenemia in Nigeria, with variable prevalence across geopolitical regions. We provided valuable evidence for implementing routine CrAg screening of AHD patients in Nigeria which has commenced in selected centres.

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Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests: DWD and family hold Founder shares in F2G Ltd, a University of Manchester spin-out antifungal discovery company, and share options in TFF Pharma. He acts or has recently acted as a consultant to Pulmatrix, Pulmocide, Biosergen, TFF Pharmaceuticals, Bright Angel Therapeutics and Cipla. He sits on the DSMB for a SARS CoV2 vaccine trial. In the last 3 years, he has been paid for talks on behalf of Hikma, Gilead, BioRad, Basilea, Mylan and Pfizer. DWD did not receive a salary from any of the commercial affiliations during the time of the study. Additionally, all commercial funding author DWD received were unrelated to, and outside of, the submitted work. All other authors declare that they have no financial or personal relationship(s) that may have inappropriately influenced them in writing this article. There are no patents, products in development or marketed products associated with this research to declare. The competing interests listed do not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Map of Nigeria showing prevalence of cryptococcal antigenaemia at the various sites.
Red–Greater than 10%; Pink–>5 to 10%; Dark orange–>3 to 5%; Light orange–>0 to 3%; Green– 0%; Grey–No data (Map created using ArcGIS, basemap available at https://basemaps.arcgis.com/arcgis/rest/services/World_Basemap_v2/VectorTileServer).
See this image and copyright information in PMC

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