Dataset Information

Survival following screening and preemptive antifungal therapy for subclinical cryptococcal disease in advanced HIV infection.

ABSTRACT:

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+ cell counts less than 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 or less, with death as the outcome. Lumbar punctures 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 at least 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 lumbar punctures 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+ cell count less than 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.

SUBMITTER: Makadzange TA

PROVIDER: S-EPMC8416705 | biostudies-literature | 2021 Oct

REPOSITORIES: biostudies-literature

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Publications

Survival following screening and preemptive antifungal therapy for subclinical cryptococcal disease in advanced HIV infection.

Makadzange Tariro Azure TA Hlupeni Admire A Machekano Rhoderick R Boyd Kathryn K Mtisi Takudzwa T Nyamayaro Primrose P Ross Christine C Vallabhaneni Snighdha S Balachandra Shirish S Chonzi Prosper P Ndhlovu Chiratidzo Ellen CE

AIDS (London, England) 20211001 12

<h4>Objectives</h4>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+ cell counts less than 100 cells/μl without symptoms of meningitis in Zimbabwe.<h4>Design</h4>This was a prospective cohort study.<h4>Methods</h4>Participants were enrolled as either sCrAg-positive or sCrAg-negative and followed up for 52 weeks or less, with death as the outcome. Lumbar punctures were recomm ...[more]

PMID: 34101629

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Dataset Information

Survival following screening and preemptive antifungal therapy for subclinical cryptococcal disease in advanced HIV infection.

Objectives

Design

Methods

Results

Conclusion

Publications

Survival following screening and preemptive antifungal therapy for subclinical cryptococcal disease in advanced HIV infection.

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