Brief Report: Geographical Variation in Prevalence of Cryptococcal Antigenemia Among HIV-Infected, Treatment-Naive Patients in Nigeria: A Multicenter Cross-Sectional Study

Abstract

Objective Worldwide, HIV-associated cryptococcal meningitis affects approximately 1 million persons and causes 600,000 deaths each year mostly in sub-Sharan Africa. Limited data exist on cryptococcal meningitis and antigenemia in Nigeria, and most studies are geographically restricted. We determined the prevalence of cryptococcal antigenemia (CrAg) among HIV-infected treatment-naïve individuals in Nigeria. Design/Methods This was a retrospective, cross-sectional study across four geographic regions in Nigeria. We performed CrAg testing using a lateral flow immunoassay on archived whole blood samples collected from HIV-infected participants at US PEPFAR-supported sites selected to represent the major geographical and ethnic diversity in Nigeria. Eligible samples were (1) stored in an -80° freezer; (2) collected from consenting patients (>15 years) naïve to antiretroviral therapy with CD4+ count less than 200 cells/mm3. Results A total of 2,752 stored blood samples were retrospectively screened for CrAg. A majority of samples were from participants aged 30 - 44 (57.6%), and 1,570 (57.1%) were from women. The prevalence of CrAg positivity in specimens with CD4 < 200 cells/mm3 was 2.3% (95% CI = 1.8%-3.0%), and varied significantly across the four regions (p < 0.001). At 4.4% (3.2%-5.9%), the South East contained the highest prevalence. Conclusion The significant regional variation in CrAg prevalence found in Nigeria should be taken into consideration as plans are made to integrate routine screening into clinical care for HIV-infected patients.

High burden of cryptococcal antigenemia and meningitis among patients presenting at an emergency department in Maputo, Mozambique

“…For this reason, the World Health Organization (WHO) recommends screening for CrAg among all individuals with a CD4 count � 100 cells/μL [5]. These recommendations are supported by a number of single-country studies from sub-Saharan Africa, most of which found either cost-savings or decreased mortality when CrAg screening programs were introduced [6][7][8][9][10][11][12][13]. CrAg screening among patients with CD4 count � 200 cells/μL, combined with a short intervention of community support, also substantially reduced mortality in a randomized controlled study at six sites in Zambia and Tanzania [14].…”

Prevalence and Associated Factors of Cryptococcal Antigenemia in HIV-Infected Patients with CD4 < 200 Cells/µL in São Paulo, Brazil: A Bayesian Analysis

“…For comparison with estimates from other regions of the world, positive LFA prevalence in patients with ≤200 cells/µL ranged from 1.69% in Cotonou, Benin to around 7% in Tanzania, Ethiopia, and Mozambique, to values higher than 10% in the north of Brazil [19][20][21][22][23][24][25][26][27][28][29][30][31]. Two previous meta-analyses among patients from several continents with CD4 < 200 cells/µL from 1997 to 2017 and from 1989 to 2021 found antigenemia prevalences of 5% (95% CI 2-7%) [43] and 4.4% (95% CI 1.6-7.4%) in the same CD4 group [2].…”

“…Different prevalences of antigenemia have been recorded by lateral flow assay in different regions of the world, ranging from 1.69% to 16.66% [17,[19][20][21][23][24][25][26][27][28][29][30][31]; even within Brazil itself, this prevalence varies from 1.3-11.66% [23,[27][28][29].…”

Health Literacy and Medication Management in Chronic Kidney Disease

“…A Medicare cost-offset model showed that increased phosphate binder medication possession ratios and percent time in range for serum phosphorus reduced overall Medicare costs, most prominently for inpatient services (Ramakrishnan et al, 2014). A separate study found a novel approach to improving phosphate binder adherence in ESRD: self-affirmation (Ezeanolue et al, 2016). Before presenting “threatening” health information about phosphate control, patients were given either self-affirming or matched control questions.…”