Cryptococcal antigenemia and its predictors among HIV infected patients in resource limited settings: a systematic review

Abstract

Background : Cryptococcosis is an opportunistic fungal infection that primarily affects people with advanced Human immunodeficiency virus (HIV) disease and is an important cause of morbidity and mortality around the globe. By far the most common presentation of the disease is cryptococcal meningitis (CM), which leads to an estimated 15-20% of all HIV related deaths worldwide, 3/4 of which are in sub-Saharan Africa. However, to the best of our knowledge there is quite limited reviewed data that on the epidemiology of cryptococcal antigenemia in a large HIV-infected population in resource limited settings. Methods : Articles published in English irrespective of the time of publication were systematically searched using comprehensive search strings from PubMed/Medline and SCOPUS. In addition, Google Scholar and Google databases were searched manually for grey literature. Two reviewers independently assessed study eligibility, extracted data, and assessed risk of bias. The magnitude of cryptococcal antigenemia and its predictors were presented with descriptive statistics and summary measures. The pooled prevalence of cryptococcal antigenemia was also determined with 95% confidence interval (CI). Result: A mong 2941 potential citations, we have included 22 studies with a total of 8,338 HIV positive individuals. The studies were reported in ten different countries during the year (2007-2018). Most of the articles reported the mean CD4 count of the participants <100 cells/µl. The pooled prevalence of cryptococcal antigenemia at different CD4 count and ART status was at 8% (95%CI: 6-10%) (ranged between 1.7% and 33%). Body mass index (BMI) <18.5kg/m 2 , CD4 count <100 cells, presenting with headache and male gender were reported by two or more articles as an important predictors of cryptococcal antigenemia. Conclusions : Implementing a targeted screening of HIV patients with low BMI, CD4 count <100 cells, having headache and males; and treatment for asymptomatic cryptococcal disease should be considered. Additional data is needed to better define the epidemiology of cryptococcal antigenemia and its predictors in resource limited settings in order to design prevention, diagnosis, and treatment strategies.

Prevalence of Cryptococcaemia in HIV Infected Patients with CD4 Counts of ≤100 Cells/mm3-A Cross Sectional Study in a Tertiary Care Hospital

“…The risk of exposure to HIV infection was heterosexual contact for all patients, except for one case (a 14-yearold boy). CD4 lymphocyte counts for female and male patients ranged from 9-205 cells/ mm 3 (mean= 59.0, SD=73.4) and 4-212 cells/ mm 3 (mean=41.8, SD=50.8), respectively [38] .…”

“…These findings suggest that in a developing country like ours, tuberculosis still remains as the most common co-infection in PLHIV. In a review study by Derbie et al (2020), a total of 8338 HIV positive individuals were reported in 22 studies conducted in ten different countries during 2007-2018. Most articles reported the mean CD4 count of participants below 100 cells/μL.…”

Efficacy of Azithromycin Injection Combined with Levofloxacin Capsule and Ambroxol Injection in the Treatment of Mycoplasma Pneumonia

“…Azithromycin is currently widely used as the first-line drug for the treatment of mycoplasma pneumonia [22,23]. Expect it, azithromycin has a wide range of antibacterial activities against pneumococcus, staphylococcus aureus, anaerobic bacteria, gram-negative bacteria, gram-positive bacteria, and has a certain inhibitory effect on chlamydia pneumoniae, chlamydia humanoid and chlamydia trachomatis [24]. Nevertheless, long-term use of azithromycin can increase the incidence of adverse reactions in different tissues of patients, such as skin, respiratory, digestive and nervous systems [25].…”