Prevalence of cryptococcal antigenuria at initial HIV diagnosis in KwaZulu-Natal

被引：8

作者：

Drain, P. K. ^{[1
]}

Kleene, J. M. ^{[2
]}

Coleman, S. M. ^{[3
]}

Losina, E. ^{[1
,4
]}

Katz, J. N. ^{[5
]}

Giddy, J. ^{[6
]}

Ross, D. ^{[7
]}

Freedberg, K. A. ^{[1
,4
]}

Bassett, I. V. ^{[1
]}

机构：

[1] Massachusetts Gen Hosp, Boston, MA 02114 USA

[2] Stony Brook Sch Med, Stony Brook, NY USA

[3] Boston Univ, Sch Publ Hlth, Boston, MA USA

[4] Harvard Univ, Sch Med, Boston, MA USA

[5] Brigham & Womens Hosp, Boston, MA 02115 USA

[6] McCord Hosp, Durban, South Africa

[7] St Marys Hosp, Durban, South Africa

来源：

HIV MEDICINE | 2015年 / 16卷 / 10期

关键词：

CD4; count; cryptococcal urine antigen; cryptococcosis; cryptococcus; diagnosis; HIV; AIDS; South Africa; SOUTH-AFRICA; ANTIGENEMIA; MENINGITIS; SERUM; CARE; THERAPY; UGANDA; ADULTS;

D O I：

10.1111/hiv.12263

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

ObjectivesThe World Health Organization (WHO) recommends screening HIV-infected people for cryptococcal antigens to identify cryptococcosis, a major cause of AIDS-related deaths. As the burden of cryptococcosis is unknown in South Africa's KwaZulu-Natal province, we assessed the cryptococcal antigenuria prevalence among newly diagnosed HIV-infected adults there. MethodsWe conducted a cross-sectional study of newly diagnosed HIV-infected adults who received voluntary HIV testing in an out-patient clinic. Participants provided a urine specimen in a sterile container, and we performed testing with a WHO-endorsed rapid cryptococcal antigen lateral flow assay (Immy Inc., Norman, OK, USA) per the manufacturer's specifications. We assessed cryptococcal antigenuria prevalence among participants with CD4 counts<200cells/L, and stratified results by CD4 count categories. ResultsAmong 432 participants, the mean (standard deviation) age was 36.1 +/- 9.9 years and 172 (40%) were female. The overall estimated prevalence of cryptococcal antigenuria was 9.0% [95% confidence interval (CI) 6.5-12.1%]. CD4 counts were available for 319 participants (74%); the median CD4 count was 75cells/L [interquartile range (IQR) 34-129cells/L]. Participants with a negative cryptococcal antigenuria screening test had a median CD4 count of 79cells/L (IQR 36-129cells/L), while participants with a positive cryptococcal test had a median CD4 count of 41cells/L (IQR 10-112cells/L). The estimated prevalence of cryptococcal antigenuria among participants with CD4 counts <50cells/L was 12.5% (95% CI 7.0-20.1%), which was significantly higher than that among participants with CD4 counts of 50-200cells/L (4.8%; 95% CI 2.3-8.7%). ConclusionsNearly 1 in 10 newly diagnosed HIV-infected adults with CD4 counts <200cells/L in KwaZulu-Natal had evidence of cryptococcal antigenuria. Point-of-care CD4 count testing and cryptococcal antigen screening may rapidly identify cryptococcosis at the time of HIV diagnosis.

引用

页码：640 / 644

页数：5

共 15 条

[1] High Prevalence of Cryptococcal Antigenemia among HIV-infected Patients Receiving Antiretroviral Therapy in Ethiopia [J].