Cryptococcal neorformans Antigenemia among HIV-Infected Patients in North Eastern Nigeria

Abstract

Background: Cryptococcus neoformans infection is a common fungal infection that is cosmopolitan in distribution and causes a life-threatening disease among HIV-infected patients especially in advanced disease. Screening for cryptococcal antigen (CrAg) in patients enrolling in ART programs may identify those at risk of cryptococcal meningitis and permit targeted use of pre-emptive therapy. Methods: This was a cross survey study of 215 consecutive HIV-infected patients at an ART treatment centre were screened for cryptococcal antigenaemia using the cryptococcal antigen lateral flow assay (CrAg LFA). Study subjects were assessed for clinical features of Cryptococcus neoformans infection. CD4+ cell count, haemoglobin concentration as well as HIV-1 RNA viral load was also compared between cryptococcal antigen positive and negatives. Results: 37 (16.7%) patients were positive for cryptococcal antigenaemia. Cryptococcal antigen positive subjects had a lower median CD4+ cell count (58 cells/uL vs. 273 cells/uL, p<0.001) and higher median viral load (log 3.6 copies/mL vs. log2.3 copies/mL, p=0.05) compared to cryptococcal antigen negative subjects. The commonest predictors of positive CrAg status in the study were; low BMI, low Hb, fever and cough. Conclusion: The study has shown the prevalence of cryptococcal antigenaemia to be high among the study subjects attending this service. Therefore, screening of patients receiving care at this centre may help in identifying individuals who are at risk of cryptococcal meningitis for prophylactic treatment.