Prospective cohort of AIDS patients screened for cryptococcal antigenaemia, pre-emptively treated and followed in Brazil
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2019
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Background
Cryptococcal meningitis has a high morbidity and mortality among AIDS population. Crypto coccal antigen (CrAg) detection is considered an independent predictor for meningitis and
death. Since 2011, the World Health Organization recommends CrAg screening for people
living with HIV/AIDS (PLHAs) with CD4 counts <100–200 cells/μl. Its implementation is still
limited in low-middle-income countries. We aimed to estimate the prevalence and predictors
of CrAg positivity in PLHAs. We also evaluated outcomes among those who were CrAg positive.
Methods
Prospective cohort conducted at an infectious diseases hospital, in Brazil. Adults with CD4
<200 cells/μl, without previous cryptococcal disease and regardless of symptoms, were
enrolled from 2015 to 2018. CrAg tests were performed by LFA. Lumbar puncture was done
in CrAg+ individuals and pre-emptive therapy was offered for those without meningitis.
Results
Of 214 individuals recruited, 88% were antiretroviral experienced, of which only 11.6% with
viral suppression. Overall, CrAg prevalence was 7.9% (95% CI, 4.7–12.4). In CD4 �100
cells/μl group it was 7.5% (95% CI, 4.1–12.6) and 9.1% (95% CI, 3.4–19.0) in the group with
CD4 101 to 199 cells/μl (p = 0.17). Prevalence in asymptomatic subjects was 5.3% (95% CI,
1.4–13.1). One among 17 CrAg+ participants had documented meningoencephalitis and no subclinical meningitis was detected. Adherence to pre-emptive treatment was 68.7% (11/
16). There were no statistically significant differences in sociodemographic, clinical or labo ratory characteristics to predict CrAg positivity. No case of cryptococcal disease was diag nosed among CrAg + subjects, followed by a median of 12 months.
Conclusions
CrAg screening for severely immunosuppressed PLHAs in Brazil yielded a prevalence of
7.9%. No difference was found in the prevalence of CrAg stratified by CD4 values (CD4
<100 versus CD4 101–199 cells/μl). No clinical nor laboratory factors predicted CrAg posi tivity, corroborating the need for the implementation of universal CrAg screening for PLHAs
with CD4 <200 cells/μl in similar settings.
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BORGES, Moara Alves Santa Bárbara et al. Prospective cohort of AIDS patients screened for cryptococcal antigenaemia, pre-emptively treated and followed in Brazil. Plos One, San Francisco, v. 14, n. 7, e0219928, 2019. DOI: 10.1371/journal.pone.0219928. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0219928. Acesso em: 17 jan. 2025.