Objectives The World Health Organization (WHO) recommends screening HIV-infected people for cryptococcal antigens to identify cryptococcosis, a major cause of AIDS-related deaths. Since the burden of cryptococcosis is unknown in South Africa’s KwaZulu-Natal province, we assessed the cryptococcal antigenuria prevalence among newly-diagnosed HIV-infected adults. Methods We conducted a cross-sectional study of newly-diagnosed HIV-infected adults who received voluntary HIV testing in an outpatient clinic. Participants provided a urine specimen in a sterile container, and we performed testing with a WHO-endorsed rapid cryptococcal antigen lateral flow assay (Immy Inc., Norman, USA) per manufacturer’s specifications. We assessed cryptococcal antigenuria prevalence among participants with CD4 <200 cells/mm3, and stratified results by CD4 categories. Results Among 432 participants, mean age was 36.1 ±9.9 years and 172 (40%) were female. The overall estimated prevalence of cryptococcal antigenuria was 9.0% (95% CI 6.5–12.1%). CD4 counts were available for 319 (74%) participants; median CD4 was 75 cells/mm3 [Interquartile Range (IQR) 34–129 cells/mm3]. Participants with a negative cryptococcal antigenuria screening test had a median CD4 of 79 cells/mm3 (IQR 36-129 cells/mm3), while participants with a positive cryptococcal test had a median CD4 of 41 cells/mm3 (IQR 10-112 cells/mm3). The estimated prevalence of cryptococcal antigenuria among participants with CD4 <50 cells/mm3 was 12.5% (95% CI 7.0-20.1%), which was significantly higher than those with CD4 50-200 cells/mm3 (4.8%; 95% CI 2.3-8.7%). Conclusions Nearly 1 of 10 newly-diagnosed HIV-infected adults with CD4 <200 cells/mm3 in KwaZulu-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.

SUMMARY Setting Four ambulatory clinics in Durban. Objective Test the relationships of patient characteristics, time to mycobacterial culture positivity, and mortality with urinary lipoarabinomannan (LAM) grade category. Design Newly diagnosed HIV-infected adults were screened for tuberculosis (TB) by sputum culture, tested for urinary LAM (Determine, Alere), and followed for up to 12 months. We performed multivariable ordinal logistic regression of risk factors for low (1 or 2) or high (3, 4, or 5) LAM grade. We used adjusted Cox regression models to determine the hazard ratios of time to culture positivity and death. Results Among 683 HIV-infected adults, median CD4 count was 215 cells/mm3 (interquartile range 86-361 cells/mm3), 17% had culture-confirmed TB, and 11% died during follow-up. Smoking, tachycardia (pulse >100 beats/minute), CD4 count <100 cells/mm3, and TB culture positivity were each associated with higher LAM grade. In multivariate models, a high urine LAM grade was associated with 4-fold increased hazard of culture positivity (p=0.001) and 2-fold increased hazard of mortality (p=0.02). Among patients treated for TB, these associations were no longer statistically significant. Conclusion In this population, a higher urine LAM grade was associated with both shorter time to culture positivity and mortality, but these associations were not present for those who starting anti-TB therapy.