Diagnostic capacity for invasive fungal infections in advanced HIV disease in Africa: a continent-wide survey

Lakoh, Sulaiman; Kamudumuli, Pocha Samuel; Penney, Richard O.S.; Haumba, Samson; Jarvis, Joseph N; Hassan, Asha  Jama; Moudoute, Ngando  Laure E.; Ocansey, Bright K.; Izco, Santiago; Kipkerich, Stephen; Sacarlal, Jahit; Awopeju, A. T. O.; Govender, Nelesh P.; Munyanji, Cleophas If Malaba; Guyguy, Kamwiziku; Orefuwa, Emma; Denning, David W.

doi:10.1016/s1473-3099(22)00656-9

Cited by 25 publications

(12 citation statements)

References 33 publications

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“…More outpatients than inpatients in this study have AHD (49.4% vs. 36.6%). This finding underscores the fact that CD4+ count and screening for opportunistic infections such as TB and cryptococcal disease are recommended in AHD patients regardless of the setting in which they are assessed (29) However, the declining trend in CD4 testing has been observed across sub-Saharan Africa. This trend poses a risk of overlooking AHD diagnoses, potentially jeopardizing the effectiveness of antiretroviral therapy (ART) programs (29).…”

Section: Discussionmentioning

confidence: 91%

Prevalence and factors associated with advanced HIV disease among young people aged 15 - 24 years in a national referral hospital in Sierra Leone: A cross-sectional study

Baldeh,

Kizito,

Lakoh

et al. 2023

Preprint

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BackgroundAdvanced HIV in young people living with HIV is an increasingly pressing public health issue in sub-Saharan Africa. Despite global progress in early HIV testing and reducing HIV-related deaths, many young people with HIV continue to experience HIV disease progression in sub-Saharan Africa. This study provides an overview of the prevalence, clinical manifestations, and factors associated with advanced HIV in young people seeking medical services in a major hospital in Sierra Leone.MethodsWe used a cross-sectional design to collect data from HIV patients aged 15 to 24 years at a major hospital in Sierra Leone between September 2022 and March 2023. Advanced HIV was defined as (i) CD4+ below 200 cells/mm3 or (ii) WHO clinical stage 3 or 4. Logistic regression models determined the association between observable independent characteristics and advanced HIV. The statistical significance level was set at 0.05 for all statistical tests.ResultsAbout 40% (231/574) of patients were recruited; 70.6% (163/231) were inpatients, and 29.4% (68/231) were outpatients. The mean age was approximately 21.6 years (SD ±2.43). The overall prevalence of advanced HIV was 42.9% (99/231), 51.5% (35/68) of outpatients, and 39.3% (64/163) of inpatients. Age of inpatients (OR, 1.23; 95% CI, 1.00-1.52; p= 0.047) was associated with a higher risk. Female sex (OR, 0.51; 95% CI, 0.28-0.94; p= 0.030), higher education (OR, 0.27; 95% CI, 0.10 – 0.78; p= 0.015), and Body Mass (OR, 0.10; 95% CI, 0.01-0.77; p= 0.028) were at lower risk of advance HIV. Common conditions diagnosed in this population are tuberculosis (13.58%), hepatitis B (6.13%), Kaposi sarcoma (3.07%), and esophageal candidiasis (2.45%).ConclusionWe reported a high prevalence of advanced HIV among young patients in a referral Hospital in Sierra Leone. This emphasises the need to strengthen public health measures and policies that address challenges of access to HIV services.Strengths and limitations of this studyThis is the first study in Sierra Leone and the sub-region to examine the burden of advanced HIV and its predictors in young people living with HIV.Calls for a more targeted approach to addressing gaps in health service delivery for young people living with HIV in Sierra Leone.The study is limited by the unavailability of several laboratory investigations to monitor patient progress.

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Section: Discussionmentioning

confidence: 91%

Prevalence and factors associated with advanced HIV disease among young people aged 15 - 24 years in a national referral hospital in Sierra Leone: A cross-sectional study

Baldeh,

Kizito,

Lakoh

et al. 2023

Preprint

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“…More complete panels should be tested and include more laboratories, also from highly endemic regions. Even if several laboratories from these areas 21,22 lacked equipment for performing PCR assays, the global severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pandemic has allowed the implementation of conventional and qPCR technologies worldwide, including laboratories with less resources, which implies that more laboratories could participate in future inter‐laboratory studies.…”

Section: Discussionmentioning

confidence: 99%

“…8 Besides these golden standards, specific antigen detection tests may be a good additional tool for the diagnosis of histoplasmosis and coccidioidomycosis; however, cross-reactions are described with other fungi, sensitivity is decreased in immunocompetent patients [13][14][15][16][17][18][19][20] and antigen detection tests are still not largely available. 21,22 As with other invasive fungal infections, the utility of antibody detection is limited, as the antibodies are produced only 4-8 weeks after exposure, may completely be absent in patients with impaired humoral immunity, and cross-reactions are possible with other fungal and granulomatous diseases 8,[23][24][25] (Table S1).…”

Section: Introductionmentioning

confidence: 99%

A multicentre external quality assessment: A first step to standardise PCR protocols for the diagnosis of histoplasmosis and coccidioidomycosis

Wilmes

Hagen

Veríssimo

et al. 2023

Mycoses

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Background: In-house real-time PCR (qPCR) is increasingly used to diagnose the socalled endemic mycoses as commercial assays are not widely available.Objectives: To compare the performance of different molecular diagnostic assays for detecting Histoplasma capsulatum and Coccidioides spp. in five European reference laboratories.Methods: Two blinded external quality assessment (EQA) panels were sent to each laboratory that performed the analysis with their in-house assays. Both panels included a range of concentrations of H. capsulatum (n = 7) and Coccidioides spp. (n = 6), negative control and DNA from other fungi. Four laboratories used specific qPCRs, and one laboratory a broad-range fungal conventional PCR (cPCR) and a specific cPCR for H. capsulatum with subsequent sequencing.Results: qPCR assays were the most sensitive for the detection of H. capsulatum DNA.The lowest amount of H. capsulatum DNA detected was 1-4 fg, 0.1 pg and 10 pg for qPCRs, specific cPCR and broad-range cPCR, respectively. False positive results occurred with high concentrations of Blastomyces dermatitidis DNA in two laboratories and with Emergomyces spp. in one laboratory. For the Coccidioides panel, the lowest amount of DNA detected was 1-16 fg by qPCRs and 10 pg with the broad-range cPCR. One laboratory reported a false positive result by qPCR with high load of Uncinocarpus DNA.

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“…Among these patients are those with HIV/AIDS and those subjected to chemotherapy or immunosuppression therapies, mainly in low-income countries with limited health resources [ 275 ]. The number of patients surviving malignancy, organ transplant, and autoimmune conditions is expected to continue to increase in the following decades [ 276 ]. Bearing these aspects in mind, financial support to low-income countries will improve the diagnosis and treatment of fungal diseases.…”

Section: Prospectsmentioning

confidence: 99%

Clinical Manifestations of Human Exposure to Fungi

Oliveira

Lisboa

et al. 2023

JoF

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Biological particles, along with inorganic gaseous and particulate pollutants, constitute an ever-present component of the atmosphere and surfaces. Among these particles are fungal species colonizing almost all ecosystems, including the human body. Although inoffensive to most people, fungi can be responsible for several health problems, such as allergic fungal diseases and fungal infections. Worldwide fungal disease incidence is increasing, with new emerging fungal diseases appearing yearly. Reasons for this increase are the expansion of life expectancy, the number of immunocompromised patients (immunosuppressive treatments for transplantation, autoimmune diseases, and immunodeficiency diseases), the number of uncontrolled underlying conditions (e.g., diabetes mellitus), and the misusage of medication (e.g., corticosteroids and broad-spectrum antibiotics). Managing fungal diseases is challenging; only four classes of antifungal drugs are available, resistance to these drugs is increasing, and no vaccines have been approved. The present work reviews the implications of fungal particles in human health from allergic diseases (i.e., allergic bronchopulmonary aspergillosis, severe asthma with fungal sensitization, thunderstorm asthma, allergic fungal rhinosinusitis, and occupational lung diseases) to infections (i.e., superficial, subcutaneous, and systemic infections). Topics such as the etiological agent, risk factors, clinical manifestations, diagnosis, and treatment will be revised to improve the knowledge of this growing health concern.

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Diagnostic capacity for invasive fungal infections in advanced HIV disease in Africa: a continent-wide survey

Cited by 25 publications

References 33 publications

Prevalence and factors associated with advanced HIV disease among young people aged 15 - 24 years in a national referral hospital in Sierra Leone: A cross-sectional study

Prevalence and factors associated with advanced HIV disease among young people aged 15 - 24 years in a national referral hospital in Sierra Leone: A cross-sectional study

A multicentre external quality assessment: A first step to standardise PCR protocols for the diagnosis of histoplasmosis and coccidioidomycosis

Clinical Manifestations of Human Exposure to Fungi

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