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

Abstract

Cryptococcosis is a severe life-threatening disease and a major cause of mortality in people with advanced AIDS and CD4 ≤ 100 cells/µL. Considering the knowledge gap regarding the benefits of routine application of antigenemia tests in HIV-infected patients with 100–200 CD4 cells/µL for the prevention of cryptococcal meningitis (CM), we aimed to evaluate the prevalence of positive antigenemia through lateral flow assay (LFA) and associated factors in HIV-infected patients with CD4 &lt; 200 cells/µL. Our findings of 3.49% of positive LFA (LFA+) patients with CD4 &lt; 100 cells/µL and 2.24% with CD4 between 100–200 cells/µL have been included in a Bayesian analysis with 12 other studies containing similar samples worldwide. This analysis showed a proportion of 3.6% LFA+ patients (95% credible interval-Ci [2.5–5.7%]) with CD4 &lt; 100 cells/µL and 1.1% (95%Ci [0.5–4.3%]) with CD4 between 100–200 cells/µL, without statistical difference between these groups. The difference between mortality rates in LFA+ and negative LFA groups was e = 0.05013. Cryptococcoma and CM were observed in the LFA+ group with 100–200 and &lt;100 CD4 cells/µL, respectively. Considering the benefits of antifungal therapy for LFA+ patients, our data reinforced the recommendation to apply LFA as a routine test in patients with 100–200 CD4 cells/µL aiming to expand cost-effectiveness studies in this group.

Clinical and mycological implications of cryptococcal meningitis in Iran

“…Enclosed and silent growth of chronic CM can cause undiagnosed central nervous system (CNS) infections in both immunocompromised and immunocompetent hosts [ 7 ]. Due to the importance of this issue, WHO guidelines recommend cryptococcal antigenemia screening for individuals with a CD4 + T cell count <100 cells/μL [ 8 , 9 ]. To develop effective public health strategies and reduce the burden of potentially life-threatening CM in Iran, an Asian country, it is important to understand the epidemiological and clinical profiles of patients with CM.…”