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Prevalence of cryptococcal antigenuria at initial HIV diagnosis in K wa Z ulu‐ N atal
Author(s) -
Drain PK,
Kleene JM,
Coleman SM,
Losina E,
Katz JN,
Giddy J,
Ross D,
Freedberg KA,
Bassett IV
Publication year - 2015
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/hiv.12263
Subject(s) - interquartile range , medicine , cryptococcosis , confidence interval , human immunodeficiency virus (hiv) , cryptococcus , immunology , cryptococcus neoformans , gastroenterology , microbiology and biotechnology , biology
Objectives The W orld H ealth O rganization ( WHO ) recommends screening HIV ‐infected people for cryptococcal antigens to identify cryptococcosis, a major cause of AIDS ‐related deaths. As the burden of cryptococcosis is unknown in S outh A frica's K wa Z ulu‐ N atal province, we assessed the cryptococcal antigenuria prevalence among newly diagnosed HIV ‐infected adults there. Methods We conducted a cross‐sectional study of newly diagnosed HIV ‐infected adults who received voluntary HIV testing in an out‐patient clinic. Participants provided a urine specimen in a sterile container, and we performed testing with a WHO ‐endorsed rapid cryptococcal antigen lateral flow assay ( I mmy I nc., N orman, OK , USA ) per the manufacturer's specifications. We assessed cryptococcal antigenuria prevalence among participants with CD4 counts < 200 cells/μL, and stratified results by CD4 count categories. Results Among 432 participants, the mean (± standard deviation) age was 36.1 ± 9.9 years and 172 (40%) were female. The overall estimated prevalence of cryptococcal antigenuria was 9.0% [95% confidence interval ( CI ) 6.5–12.1%]. CD4 counts were available for 319 participants (74%); the median CD4 count was 75 cells/μL [interquartile range ( IQR ) 34–129 cells/μL]. Participants with a negative cryptococcal antigenuria screening test had a median CD4 count of 79 cells/μL ( IQR 36–129 cells/μL), while participants with a positive cryptococcal test had a median CD4 count of 41 cells/μL ( IQR 10–112 cells/μL). The estimated prevalence of cryptococcal antigenuria among participants with CD4 counts < 50 cells/μL was 12.5% (95% CI 7.0–20.1%), which was significantly higher than that among participants with CD4 counts of 50–200 cells/μL (4.8%; 95% CI 2.3–8.7%). Conclusions Nearly 1 in 10 newly diagnosed HIV ‐infected adults with CD4 counts < 200 cells/μL in K wa Z ulu‐Natal had evidence of cryptococcal antigenuria. Point‐of‐care CD4 count testing and cryptococcal antigen screening may rapidly identify cryptococcosis at the time of HIV diagnosis.