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Survival following screening and preemptive antifungal therapy for subclinical cryptococcal disease in advanced HIV infection.
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10 01 2021
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Source: AIDS. 35(12):1929-1938
[PDF-894.24 KB]
Details:
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Alternative Title:AIDS
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Personal Author:
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Description:Objectives:
Our study’s primary objective was to compare 1-year survival rates between serum cryptococcal antigen (sCrAg)-positive and sCrAg-negative HIV-positive individuals with CD4 counts <100 cells/μl without symptoms of meningitis in Zimbabwe.
Design:
This was a prospective cohort study.
Methods:
Participants were enrolled as either sCrAg-positive or sCrAg-negative and followed up for ≤52 weeks, with death as the outcome. Lumbar punctures (LPs) were recommended to all sCrAg-positives and inpatient management with intravenous amphotericin B and high-dose fluconazole was recommended to those with disseminated Cryptococcus. Antiretroviral therapy was initiated immediately in sCrAg-negatives and after ≥4 weeks following initiation of antifungals in sCrAg-positives. Multivariable logistic regression models were used to determine risk factors for mortality.
Results:
We enrolled 1320 participants and 130 (9.8%) were sCrAg positive, with a median sCrAg titre of 1:20. Sixty-six (50.8%) sCrAg-positives had LPs and 16.7% (11/66) had central nervous system (CNS) dissemination. Cryptococcal blood cultures were performed in 129 sCrAg-positives, with 10 (7.8%) being positive. One-year (48–52 weeks) survival rates were 83.9% and 76.1 % in sCrAg-negatives and sCrAg-positives, respectively, p=0.011. Factors associated with increased mortality were a positive sCrAg, CD4 count <50 cells/μl and having presumptive tuberculosis (TB) symptoms.
Conclusion:
Our study reports a high prevalence of subclinical cryptococcal antigenemia and reiterates the importance of TB and a positive sCrAg as risk factors for mortality in advanced HIV disease (AHD). Therefore, TB and sCrAg screening remains a crucial component of AHD package, hence it should always be part of the comprehensive clinical evaluation in AHD patients.
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Source:
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Pubmed ID:34101629
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Pubmed Central ID:PMC8416705
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