Prevalence of Cryptococcal Antigen and Outcomes in People With Human Immunodeficiency Virus in Honduras: A Cohort Study

Zuniga-Moya, Julio Cesar; Romero-Reyes, Luis Enrique; Saavedra, Emilio Barrueto; Montoya, Sandra Fabiana; Varela, Diana E.; Borjas, Mitchel; Cerna, Alicia; Bejarano, Suyapa; Martínez, Paola; Lujan, Karen; Erazo, Karen; Lainez, Isis; Pineda, Luisamaria; Yanes, David; O’Halloran, Jane A.; Spec, Andrej

doi:10.1093/ofid/ofaa557

Cited by 3 publications

(6 citation statements)

References 21 publications

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“…For more information about the reporting criteria in each country, see Supplementary Data (Supplementary Material) . Considering all regional publications, four reported the frequency of CrAg in patients with ≤100 cells/mm 3 [ 9 , 10 , 11 , 12 ] and three in patients with <200 cells/mm 3 [ 9 , 13 , 14 ]. Using these results and ours, the estimated overall CrAg frequency in the region for PLWHIV with <100 CD4 cells/mm 3 was 9.2% (IC95% 7.9–10.7%) and 8.1% in those with AHD (IC95% 7.9–10.7%).…”

Section: Resultsmentioning

confidence: 99%

“…Among Latin American people with HIV, we estimated that CrAg positivity is 9.2% (IC95% 7.9–10.7%) in patients with <100 CD4/mm 3 [ 9 , 10 , 11 , 12 , 13 , 14 ]. This number is 3.2% higher than the global estimation by Rajasingham et al in asymptomatic patients [ 2 ], which is an uncertain denomination considering the deep immunosuppressed status of such HIV patients.…”

Section: Discussionmentioning

confidence: 99%

“…This number is 3.2% higher than the global estimation by Rajasingham et al in asymptomatic patients [ 2 ], which is an uncertain denomination considering the deep immunosuppressed status of such HIV patients. In published articles from Brazil, Argentina and Honduras, the criteria to establish the burden of cryptococcal disease were similar, with CD4 thresholds of <100 or <200 cells/mm 3 [ 10 , 11 , 13 ]. However, in Guatemala, we screened patients regardless of the CD4 cell count, symptoms, or hospitalized status, with an overall incidence of 4.8% ( Table 2 ), which is a real measurement of the burden of disease in PLWHIV.…”

Section: Discussionmentioning

confidence: 99%

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Epidemiology and Mortality of Cryptococcal Disease in Guatemala: Two-Year Results of a Cryptococcal Antigen Screening Program

Medina¹,

Rodríguez-Tudela²,

Pérez

et al. 2022

Microorganisms

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Cryptococcal disease is an important opportunistic infection among people living with HIV. The cryptococcal antigen (CrAg) can be detected before the clinical onset of meningitis and its screening is recommended. Here, we evaluated CrAg frequency, and describe the epidemiological characteristics and mortality at 180 days in a cohort of HIV patients from Guatemala. A total of 3457 patients were screened with a CrAg lateral flow assay in serum between January 2017 and December 2018. CrAg positivity was 11.5% in patients with ≤100 CD4/mm3, 8.7% in patients with <200 CD4/mm3, and 6.3% in patients with <350 CD4/mm3. In Latin America, we estimated 9.2% CrAg positivity (IC95% 7.9–10.7%) in patients with ≤100 CD4/mm3. Among patients newly diagnosed with HIV, we estimated 4416 incident cases per year in Latin America in those with <200 CD4/mm3 and 5289 in those with <350 CD4/mm3. In addition, we calculated the burden in people not on ARV or without viral suppression and found 28,672 cases. CrAg screening should be considered in patients who have a CD4 cell count < 350 cells/mm3. Cryptococcal meningitis was associated with 30.8% mortality in Guatemala. Global access to diagnosis as well as to liposomal amphotericin B and flucytosine is a priority.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Epidemiology and Mortality of Cryptococcal Disease in Guatemala: Two-Year Results of a Cryptococcal Antigen Screening Program

Medina¹,

Rodríguez-Tudela²,

Pérez

et al. 2022

Microorganisms

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“…The overall prevalence was of 12.7% and was 40% among hospitalised patients. The 12‐month mortality rate was 11.4% 37 . Based on information from this recent study, approximately 452 cases and 52 deaths per year are assumed to occur in PLHIV at risk for OIs assuming that 66% of the PLHIV population at risk for OIs had a CD4 of <100 cells/mm 3 .…”

Section: Resultsmentioning

confidence: 99%

“…The 12-month mortality rate was 11.4%. 37 Based on information from this recent study, approximately 452 cases and 52…”

Section: Cryptococcosismentioning

confidence: 99%

Burden of serious fungal infections in Honduras

Higuita

Bustillo

Denning

2022

Mycoses

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Background The burden of serious fungal infections in Honduras is unknown. The diagnosis of fungal diseases relies on almost exclusively on microscopy and culture limiting an accurate estimate of the burden of disease. Objectives The primary objective of the study was to estimate the burden of serious fungal infections in Honduras using previously described methods. Methods National and international demographic data on population, HIV, tuberculosis, asthma, COPD and cancer were obtained. A thorough literature search was done for all epidemiological studies and case series of serious fungal diseases. Using these risk populations and whatever incidence and prevalence could be found that was most pertinent to Honduras, a burden estimate was derived. Results The estimated number of serious fungal infection was estimated to be between 178,772 and 179,624 with nearly 2300 cases of these representing opportunistic infections in people living with HIV. The incidence of histoplasmosis and cryptococcosis in people living with HIV is high and estimated to be 4.3 and 4.6 cases per 100,000 population respectively. Approximately 12,247–13,099 cases of aspergillosis and 164,227 of other serious fungal infections were estimated to occur each year. Conclusion An accurate estimate of the burden of serious fungal infections in Honduras is unknown but based on our results, likely significant. Serious fungal infections represent an important public health problem in Honduras affecting approximately 1.8% of the population. There is a clear need for better access to diagnostic tools and antifungals to conduct research to better understand the impact of fungal diseases in Honduras.

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Strengthening Fungal Infection Diagnosis and Treatment: An In-depth Analysis of Capabilities in Honduras

Ortiz,

Varela,

Fontecha

et al. 2024

Open Forum Infectious Diseases

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Background Invasive fungal infections (IFI) are a major public health concern in low- and middle-income countries (LMICs) due to limited diagnostic and treatment resources, leading to high morbidity and mortality. Despite their significant global burden, IFI are under-recognized and under-diagnosed in LMICs. This study evaluates the diagnostic and therapeutic capacities for managing IFI in Honduras, a country with unique healthcare challenges. Methods From March to December 2023, a comprehensive survey was conducted across multiple healthcare centers in Honduras. The survey, reviewed for content and clarity by local medical institutions, targeted medical microbiologists and clinicians to assess various aspects of fungal disease diagnosis and treatment. Data collected included the availability and use of diagnostic tools and antifungal therapies, identifying gaps and limitations in current practices. Results The survey revealed that Candida spp. (97.4%) and Aspergillus spp. (35.9%) were the most concerning pathogens. Although microscopy and culture methods were available in most institutions, their application in suspected IFI cases was inconsistent, and antifungal susceptibility testing was rarely performed. Advanced diagnostic techniques, such as antigen detection, were available in only a few institutions, while antibody detection and PCR testing were entirely absent. All hospitals had access to at least one triazole antifungal, typically fluconazole, but there was a notable scarcity of more potent antifungals, including amphotericin B formulations and echinocandins. The limited use of available diagnostic tools and the restricted availability of essential antifungals were identified as major barriers to effective IFI management. Conclusions This study highlights significant gaps in the diagnostic and therapeutic capabilities for managing IFI in Honduras. The underutilization of basic diagnostic tools, the inaccessibility of advanced testing methods, and the limited availability of essential antifungal medications underscore the urgent need for capacity-building initiatives, infrastructure improvements, and policy reforms. Addressing these deficiencies is critical for enhancing the management of IFI in Honduras, with broader implications for similar LMIC settings. These findings can inform targeted interventions and resource allocation to improve outcomes for patients suffering from IFI.

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Prevalence of Cryptococcal Antigen and Outcomes in People With Human Immunodeficiency Virus in Honduras: A Cohort Study

Cited by 3 publications

References 21 publications

Epidemiology and Mortality of Cryptococcal Disease in Guatemala: Two-Year Results of a Cryptococcal Antigen Screening Program

Epidemiology and Mortality of Cryptococcal Disease in Guatemala: Two-Year Results of a Cryptococcal Antigen Screening Program

Burden of serious fungal infections in Honduras

Strengthening Fungal Infection Diagnosis and Treatment: An In-depth Analysis of Capabilities in Honduras

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