Our study’s primary objective was to compare 1-year survival rates between serum cryptococcal antigen (sCrAg)-positive and sCrAg-negative HIV-positive individuals with CD4 counts <100 cells/μl without symptoms of meningitis in Zimbabwe.
This was a prospective cohort study.
Participants were enrolled as either sCrAg-positive or sCrAg-negative and followed up for ≤52 weeks, with death as the outcome. Lumbar punctures (LPs) were recommended to all sCrAg-positives and inpatient management with intravenous amphotericin B and high-dose fluconazole was recommended to those with disseminated Cryptococcus. Antiretroviral therapy was initiated immediately in sCrAg-negatives and after ≥4 weeks following initiation of antifungals in sCrAg-positives. Multivariable logistic regression models were used to determine risk factors for mortality.
We enrolled 1320 participants and 130 (9.8%) were sCrAg positive, with a median sCrAg titre of 1:20. Sixty-six (50.8%) sCrAg-positives had LPs and 16.7% (11/66) had central nervous system (CNS) dissemination. Cryptococcal blood cultures were performed in 129 sCrAg-positives, with 10 (7.8%) being positive. One-year (48-52 weeks) survival rates were 83.9% and 76.1% in sCrAg-negatives and sCrAg-positives, respectively, p = 0.011. Factors associated with increased mortality were a positive sCrAg, CD4 count <50 cells/μl and having presumptive tuberculosis (TB) symptoms.
Our study reports a high prevalence of subclinical cryptococcal antigenemia and reiterates the importance of TB and a positive sCrAg as risk factors for mortality in advanced HIV disease (AHD). Therefore, TB and sCrAg screening remains a crucial component of AHD package, hence it should always be part of the comprehensive clinical evaluation in AHD patients.
Copyright © 2021 Wolters Kluwer Health, Inc.
About The Expert
Tariro Azure Makadzange
Admire Hlupeni
Rhoderick Machekano
Kathryn Boyd
Takudzwa Mtisi
Primrose Nyamayaro
Christine Ross
Snighdha Vallabhaneni
Shirish Balachandra
Prosper Chonzi
Chiratidzo Ellen Ndhlovu
References
PubMed