Cryptococcal antigenemia is associated with meningitis or death in HIV-infected adults with CD4 100-200 cells/mm
AIDS-Related Opportunistic Infections
/ epidemiology
Adult
Antifungal Agents
/ therapeutic use
Antigens, Fungal
/ blood
CD4 Lymphocyte Count
Comorbidity
Cryptococcus
/ immunology
Female
Fluconazole
/ therapeutic use
Follow-Up Studies
Humans
Incidence
Male
Mass Screening
/ methods
Meningitis, Cryptococcal
/ drug therapy
Prospective Studies
South Africa
/ epidemiology
Young Adult
Cryptococcal antigen
Cryptococcal meningitis
HIV
Opportunistic infections
Screening
Sub-Saharan Africa
Journal
BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551
Informations de publication
Date de publication:
20 Jan 2020
20 Jan 2020
Historique:
received:
25
10
2019
accepted:
15
01
2020
entrez:
22
1
2020
pubmed:
22
1
2020
medline:
9
4
2020
Statut:
epublish
Résumé
Cryptococcal antigen (CrAg) screening with fluconazole prophylaxis has been shown to prevent cryptococcal meningitis and mortality for people living with HIV (PLWH) with CD4 < 100 cells/mm We conducted a prospective cohort study of PLWH 18+ years who had not initiated ART in South Africa. We followed participants for 14 months to determine onset of cryptococcal meningitis or all-cause mortality. At study completion, we retrospectively tested stored serum samples for CrAg using an enzyme immunoassay (EIA). We calculated CD4-stratified incidence rates of outcomes and used Cox proportional hazards to measure associations between CrAg positivity and outcomes. We enrolled 2383 PLWH, and 1309 participants had serum samples tested by CrAg EIA. The median CD4 was 317 cells/mm Although few PLWH with moderate immunosuppression screened CrAg positive, a positive CrAg test was predictive of increased risk of cryptococcal meningitis or death. Similar to those with a CD4 < 100 cell/mm
Sections du résumé
BACKGROUND
BACKGROUND
Cryptococcal antigen (CrAg) screening with fluconazole prophylaxis has been shown to prevent cryptococcal meningitis and mortality for people living with HIV (PLWH) with CD4 < 100 cells/mm
METHODS
METHODS
We conducted a prospective cohort study of PLWH 18+ years who had not initiated ART in South Africa. We followed participants for 14 months to determine onset of cryptococcal meningitis or all-cause mortality. At study completion, we retrospectively tested stored serum samples for CrAg using an enzyme immunoassay (EIA). We calculated CD4-stratified incidence rates of outcomes and used Cox proportional hazards to measure associations between CrAg positivity and outcomes.
RESULTS
RESULTS
We enrolled 2383 PLWH, and 1309 participants had serum samples tested by CrAg EIA. The median CD4 was 317 cells/mm
CONCLUSIONS
CONCLUSIONS
Although few PLWH with moderate immunosuppression screened CrAg positive, a positive CrAg test was predictive of increased risk of cryptococcal meningitis or death. Similar to those with a CD4 < 100 cell/mm
Identifiants
pubmed: 31959112
doi: 10.1186/s12879-020-4798-1
pii: 10.1186/s12879-020-4798-1
pmc: PMC6971851
doi:
Substances chimiques
Antifungal Agents
0
Antigens, Fungal
0
Fluconazole
8VZV102JFY
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
61Subventions
Organisme : NIAID NIH HHS
ID : K23 AI108293
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI060354
Pays : United States
Organisme : National Institute of Allergy and Infectious Diseases
ID : K23 AI108293]
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