Increased mortality among HIV infected patients with cryptococcal antigenemia in Guinea-Bissau

• Published in: The Pan African medical journal Vol. 29; no. 18; p. 18
• Main Authors: Thomsen, Ditte, Hviid, Cecilie Juul, Hønge, Bo Langhoff, Medina, Candida, Té, David Da Silva, Correira, Faustino Gomes, Østergaard, Lars, Erikstrup, Christian, Wejse, Christian, Laursen, Alex Lund, Jespersen, Sanne
• Format: Journal Article
• Language: English
• Published: Uganda African Field Epidemiology Network 2018; The African Field Epidemiology Network; The Pan African Medical Journal
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; AIDS-Related Opportunistic Infections - diagnosis; AIDS-Related Opportunistic Infections - microbiology; antigen screening; Antigens, Fungal - blood; CD4 Lymphocyte Count; cryptococcal antigenemia; cryptococcal meningitis; Cryptococcus - isolation & purification; Female; Follow-Up Studies; Guinea-Bissau; HIV; HIV Infections - complications; Hospitals; Human immunodeficiency virus; Humans; Infections; Laboratories; lateral flow assay; Male; Meningitis; Meningitis, Cryptococcal - diagnosis; Mortality; Retrospective Studies; Short Communication; Sociodemographics; Denmark; United States > US; Guinea Bissau; Aarhus Denmark; antigen screening; Guinea-Bissau; HIV; cryptococcal meningitis; lateral flow assay; Cryptococcal antigenemia
• ISSN: 1937-8688; 1937-8688
• DOI: 10.11604/pamj.2018.29.18.14099

Cryptococcal antigenemia may precede development of cryptococcal meningitis and death among patients with advanced HIV infection. Among 200 retrospectively and randomly selected ART-naïve patients with CD4 counts < 100 cells/μl from Guinea-Bissau, 20 (10%) had a positive cryptococcal antigen test. Self-reported headache and fever were predictors of a positive test, while cryptococcal antigenemia was a strong predictor of death within the first year of follow-up, MRR 2.22 (95% CI: 1.15-4.30). Screening for cryptococcal antigenemia should be implemented for patients with advanced HIV in Guinea-Bissau. Pre-emptive anti-fungal therapy should be initiated prior to ART-initiation if the screening is positive.