dc.contributor.author |
Letang, Emilio |
dc.contributor.author |
Muller, Matthias C. |
dc.contributor.author |
Ntamatungiro, Alex J. |
dc.contributor.author |
Kimera, Namvua |
dc.contributor.author |
Faini, Diana |
dc.contributor.author |
Furrer, Hansjakob |
dc.contributor.author |
Battegay, Manuel |
dc.contributor.author |
Tanner, Marcel |
dc.contributor.author |
Hatz, Christoph |
dc.contributor.author |
Boulware, David R. |
dc.contributor.author |
Glass, Tracy R. |
dc.date |
2016-02-04T13:40:23Z |
dc.date |
2016-02-04T13:40:23Z |
dc.date |
2015-04-02 |
dc.date |
2016-02-02T15:35:03Z |
dc.identifier.citation |
2328-8957 |
dc.identifier.uri |
http://hdl.handle.net/2445/69258 |
dc.format |
8 p. |
dc.format |
application/pdf |
dc.language.iso |
eng |
dc.publisher |
Oxford University Press |
dc.relation |
Reproducció del document publicat a: http://dx.doi.org/10.1093/ofid/ofv046 |
dc.relation |
Open Forum Infectious Diseases, 2015, vol. 2, num. 2, p. 1-8 |
dc.relation |
http://dx.doi.org/10.1093/ofid/ofv046 |
dc.rights |
cc by-nc-nd (c) Letang et al., 2015 |
dc.rights |
info:eu-repo/semantics/openAccess |
dc.rights |
http://creativecommons.org/licenses/by-nc-nd/3.0/es/ |
dc.subject |
Comorbiditat |
dc.subject |
Meningitis |
dc.subject |
Infeccions per VIH |
dc.subject |
Micologia mèdica |
dc.subject |
Comorbidity |
dc.subject |
Meningitis |
dc.subject |
HIV infections |
dc.subject |
Medical mycology |
dc.title |
Cryptococcal Antigenemia in Immunocompromised Human
Immunodeficiency Virus Patients in Rural Tanzania: A Preventable
Cause of Early Mortality |
dc.type |
info:eu-repo/semantics/article |
dc.type |
info:eu-repo/semantics/publishedVersion |
dc.description.abstract |
Background. Cryptococcal meningitis is a leading cause of death
in people living with human immunodeficiency virus
(HIV)/acquired immune deficiency syndrome. The World Health
Organizations recommends pre-antiretroviral treatment (ART)
cryptococcal antigen (CRAG) screening in persons with CD4 below
100 cells/microL. We assessed the prevalence and outcome of
cryptococcal antigenemia in rural southern Tanzania. Methods. We
conducted a retrospective study including all ART-naive adults
with CD4 <150 cells/microL prospectively enrolled in the
Kilombero and Ulanga Antiretroviral Cohort between 2008 and
2012. Cryptococcal antigen was assessed in cryopreserved pre-ART
plasma. Cox regression estimated the composite outcome of death
or loss to follow-up (LFU) by CRAG status and fluconazole use.
Results. Of 750 ART-naive adults, 28 (3.7%) were CRAG-positive,
corresponding to a prevalence of 4.4% (23 of 520) in CD4 <100
and 2.2% (5 of 230) in CD4 100-150 cells/microL. Within 1 year,
75% (21 of 28) of CRAG-positive and 42% (302 of 722) of
CRAG-negative patients were dead or LFU (P<.001), with no
differences across CD4 strata. Cryptococcal antigen positivity
was an independent predictor of death or LFU after adjusting for
relevant confounders (hazard ratio [HR], 2.50; 95% confidence
interval [CI], 1.29-4.83; P = .006). Cryptococcal meningitis
occurred in 39% (11 of 28) of CRAG-positive patients, with
similar retention-in-care regardless of meningitis diagnosis (P
= .8). Cryptococcal antigen titer >1:160 was associated with
meningitis development (odds ratio, 4.83; 95% CI, 1.24-8.41; P =
.008). Fluconazole receipt decreased death or LFU in
CRAG-positive patients (HR, 0.18; 95% CI, .04-.78; P = .022).
Conclusions. Cryptococcal antigenemia predicted mortality or LFU
among ART-naive HIV-infected persons with CD4 <150
cells/microL, and fluconazole increased survival or
retention-in-care, suggesting that targeted pre-ART CRAG
screening may decrease early mortality or LFU. A CRAG screening
threshold of CD4 <100 cells/microL missed 18% of
CRAG-positive patients, suggesting guidelines should consider a
higher threshold. |