The role of serum cryptococcal antigen screening for the early diagnosis of cryptococcosis in HIV-infected patients with different ranges of CD4 cell counts

  • Pongsai P
  • Atamasirikul K
  • Sungkanuparph S
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Abstract

OBJECTIVE: To determine the role of serum cryptococcal antigen (SCA) for the screening of cryptococcosis in HIV-infected patients with different ranges of CD4 cell counts. METHODS: A retrospective cohort study was conducted in antiretroviral-naive HIV-infected patients who had no symptom and had been screened with SCA in a tertiary-care hospital. Prevalence of positive SCA at different ranges of CD4 cell counts, risk factor of positive SCA, and incidence of cryptococcosis during one-year follow-up period after negative SCA were determined. RESULTS: There were 131 patients with a mean age of 38.5 years; 61.8% were male. Median (range) CD4 was 62 (3-590) cells/mm(3). The overall prevalence of positive SCA was 9.2%. This prevalence in patients with CD4 < 100, 100-199, and >or=200 cells/mm(3) were 12.9%, 3.6%, and 0%, respectively (P = 0.041). In multivariate analysis, CD4 < 100 cells/mm(3) was associated with positive SCA (OR = 6.69; 95% CI, 1.03-23.56). Four (33.3%) of 12 patients with positive SCA had cryptococcosis whereas one (0.8%) of 119 patients with negative SCA developed meningitis at one-year follow-up. CONCLUSIONS: SCA screening has a substantial role for the early detection of cryptococcal infection in HIV-infected patients with low CD4 cell counts. Routine screening with SCA should be performed in patients with CD4 < 100 cells/mm(3).

Author-supplied keywords

  • AIDS-Related Opportunistic Infections/blood/*diagn
  • Adult
  • Antigens, Fungal/*blood
  • CD4 Lymphocyte Count
  • CD4-Positive T-Lymphocytes/*immunology
  • Cohort Studies
  • Cryptococcosis/blood/*diagnosis/immunology/*virolo
  • Cryptococcus neoformans/isolation & purification
  • Female
  • Hiv-1
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Retrospective Studies
  • Statistics, Nonparametric

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Authors

  • P Pongsai

  • K Atamasirikul

  • S Sungkanuparph

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