Prevalence of cryptococcal antigenemia and cost-effectiveness of a cryptococcal antigen screening program--Vietnam

• Published in: PloS one Vol. 8; no. 4; p. e62213
• Main Authors: Smith, Rachel M, Nguyen, Tuan Anh, Ha, Hoang Thi Thanh, Thang, Pham Hong, Thuy, Cao, Lien, Truong Xuan, Bui, Hien T, Le, Thai Hung, Struminger, Bruce, McConnell, Michelle S, Fanfair, Robyn Neblett, Park, Benjamin J, Harris, Julie R
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 23.04.2013; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Adults; AIDS; AIDS-Related Opportunistic Infections - economics; AIDS-Related Opportunistic Infections - epidemiology; AIDS-Related Opportunistic Infections - immunology; Antigenemia; Antigens; Antigens, Fungal - blood; Antiretroviral drugs; Antiretroviral therapy; CD4 antigen; CD4 Lymphocyte Count; Cost estimates; Cost-Benefit Analysis; Cryptococcus - immunology; Economic aspects; Fungal infections; Guidelines; Health aspects; Health screening; HIV; HIV tests; Human immunodeficiency virus; Humans; Mass Screening - economics; Medical screening; Medicine; Meningitis; Meningitis, Cryptococcal - economics; Meningitis, Cryptococcal - epidemiology; Meningitis, Cryptococcal - immunology; Mortality; Patients; Prevalence; Public health; Sampling methods; Vietnam - epidemiology; Vietnam; Atlanta Georgia; Southeast Asia; Georgia; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0062213

An estimated 120,000 HIV-associated cryptococcal meningitis (CM) cases occur each year in South and Southeast Asia; early treatment may improve outcomes. The World Health Organization (WHO) recently recommended screening HIV-infected adults with CD4<100 cells/mm(3) for serum cryptococcal antigen (CrAg), a marker of early cryptococcal infection, in areas of high CrAg prevalence. We evaluated CrAg prevalence and cost-effectiveness of this screening strategy in HIV-infected adults in northern and southern Vietnam. Serum samples were collected and stored during 2009-2012 in Hanoi and Ho Chi Minh City, Vietnam, from HIV-infected, ART-naïve patients presenting to care in 12 clinics. All specimens from patients with CD4<100 cells/mm(3) were tested using the CrAg lateral flow assay. We obtained cost estimates from laboratory staff, clinicians and hospital administrators in Vietnam, and evaluated cost-effectiveness using WHO guidelines. Sera from 226 patients [104 (46%) from North Vietnam and 122 (54%) from the South] with CD4<100 cells/mm(3) were available for CrAg testing. Median CD4 count was 40 (range 0-99) cells/mm(3). Nine (4%; 95% CI 2-7%) specimens were CrAg-positive. CrAg prevalence was higher in South Vietnam (6%; 95% CI 3-11%) than in North Vietnam (2%; 95% CI 0-6%) (p = 0.18). Cost per life-year gained under a screening scenario was $190, $137, and $119 at CrAg prevalences of 2%, 4% and 6%, respectively. CrAg prevalence was higher in southern compared with northern Vietnam; however, CrAg screening would be considered cost-effective by WHO criteria in both regions. Public health officials in Vietnam should consider adding cryptococcal screening to existing national guidelines for HIV/AIDS care.