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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.

Prevalence of cryptococcal antigenuria at initial HIV diagnosis in K wa Z ulu‐ N atal