Background: There is a high burden of
HIV-related cryptococcal meningitis in Sub-Saharan Africa and it is a leading
cause of morbidity and early mortality among severely immunocompromised
patients. Objectives of the Study: This study was carried out to determine the
prevalence of cryptococcal antigen (CrAg) and the relationship of positivity to
CD4+ve T cell counts and WHO clinical stage among severely immunocompromised
treatment naive adult HIV-infected Nigerian patients. Methods: This was a
hospital based cross sectional and prospective study carried out among newly
diagnosed and confirmed HIV infected patients. Bio data of consenting
consecutive subjects was collected by the attending physician using structured
questionnaire. Rapid point of care lateral flow assay kits (IMMY, USA) was used
to screen plasma samples from subjects strictly following manufacturer’s
instructions. Data were analysed with statistical package for social sciences
(spss 15.0) software. Results were presented in simple tables with frequencies
and percentages while statistical significance was taken to be p value ≤ 0.05.
Results: Of 432 subjects, there were 184 (42.6%) males and 248 (57.4%) females
in the study. The median CD4 count of the subjects was 74 (range 6 - 1264)
cells/ul. Seven (1.6%) of the subjects were positive for cryptococcal antigen
(CrAg) and all were females (100%). Six (85.7%) of CrAg positives had CD4+ T
cell count less than 100 cells, while 1 (14.3%) had count above 200cells/ul.
The WHO clinical stage of studied patients was; stage I 163 (37.7%), stage II
132 (30.6%) stage III 95 (22.0%) and stage IV 42 (9.7%). Among the CrAg
positive subjects, 3 (42.9%) were in WHO clinical stage l while 4 (57.1%) were
in stage II disease. Conclusion: The observed overall prevalence of CrAg
positivity among studied patients was low but occurred most frequently among
the severely immunocompromised subjects. Advancement in WHO clinical stage was
not a predicting risk factor for cryptococcal antigenaemia in studied adult HIV
Park, B.J., Wannemuehler, K.A., Marston, B.J., Govender, N., Pappas, P.J. and Chiller, T.M. (2009) Estimation of the Current Global Burden of Cryptococcal Meningitis among Persons Living with HIV/AIDS. AIDS, 23, 525-530. http://dx.doi.org/10.1097/QAD.0b013e328322ffac
French, N., Gray, K., Watera, C., Nakiyinyi, J., Lugada, E., Moore, M., Lalloo, D., Whitworth, J.A. and Gilks, C.E. (2002) Cryptococcus Infection in a Cohort of HIV-1 Infected Ugandan Adults. AIDS, 16, 1031-1038. http://dx.doi.org/10.1097/00002030-200205030-00009
Corbett, E.L., Churchyard, G.J., Charalambos, S., Samb, B., Moloi, V., Clayton, T.C., Grant, A.D., Murray, J., Hayes, R.J. and De Cock, K.M. (2002) Morbidity and Mortality in South African Goldminers: Impact of Untreated Disease Due to Human Immunodeficiency Virus. Clinical Infectious Diseases, 1, 1251-1258.
Lortholary, O., Poizat, G., Zeller, V., Neuville, S., Boibieux, A., Alvarez, M., Dellamonica, P., Botterel, F., Dromer, F. and Chêne, G. (2006) Longterm Outcome of AIDS Associated Cryptococcosis in the Era of Combination Antiretroviral Therapy. AIDS, 20, 2183-2191. http://dx.doi.org/10.1097/01.aids.0000252060.80704.68
Seboxa, T., Alemu, S., Assefa, A. and Diro, E. (2010) Cryptococcal Meningitis in Patients with Acquired Immunodeficiency Syndrome in Prehaart Era at Gondar College of Medical Sciences Hospital North West Ethiopia. Ethiopian Medical Journal, 48, 237-241.
Lawn, S.D., Bekker, L.G., Myer, L., Orrell, C. and Wood, R. (2005) Cryptococcal Immune Reconstitution Disease: A Major Cause of Early Mortality in a South African Antiretroviral Program. AIDS, 19, 2050-2052. http://dx.doi.org/10.1097/01.aids.0000191232.16111.f9
Etard, J.F., Ndiaye, I., Thierry-Mieg, M., Guèye, N.F., Guèye, P.M., Lanièce, I., Dieng, A.B., Diouf, A., Laurent, C., Mboup, S., Sow, P.S. and Delaporte, E. (2006) Mortality and Causes of Death in Adults Receiving Highly Active Antiretroviral Therapy in Senegal: A 7 Year Cohort Study. AIDS, 20, 1181-1189. http://dx.doi.org/10.1097/01.aids.0000226959.87471.01
Jarvis, J.N., Meintjes, G. and Harrison, T.S. (2010) Outcomes of Cryptococcal Meningitis in Antiretroviral Naive and Experienced Patients in South Africa. Journal of Infection, 60, 496-498. http://dx.doi.org/10.1016/j.jinf.2010.03.007
Jarvis, J.N., Lawn, S.D., Vogt, M., Bangani, N., Wood, R. and Harrison, T.S. (2009) Screening for Cryptococcal Antigenaemia in Patients Accessing an Antiretroviral Treatment Program in South Africa. Clinical Infectious Diseases, 48, 856-862. http://dx.doi.org/10.1086/597262
Micol, R., Lortholary, O., Sar, B., Laureillard, D., Ngeth, C., Dousset, J.P., Chanroeun, H., Ferradini, L., Guerin, P.J., Dromer, F. and Fontanet, A. (2007) Prevalence, Determinants of Positivity and Clinical Utility of Cryptococcal Antigenaemia in Cambodian HIV-Infected Patients. Journal of Acquired Immune Deficiency Syndromes, 45, 555-559. http://dx.doi.org/10.1097/QAI.0b013e31811ed32c
Osazuwa, F., Daisu, J.O., Okuonghae, P.E. and Ugbebor, O. (2012) Screening for Cryptococcal Antigenaemia in Anti-Retroviral Naive AIDS Patients in Benin City, Nigeria. Oman Medical Journal, 27, 228-231. http://dx.doi.org/10.5001/omj.2012.51
Dhana, A. (2013) Diagnosis of Cryptococcosis and Prevention of Cryptococcal Meningitis Using a Novel Point-of-Care Lateral Flow Assay. Case Reports in Medicine, 2015, Article ID: 640216. http://dx.doi.org/10.1155/2013/640216
Jarvis, J.N., Harrison, T.S., Lawn, S.D., Meintjes, G., Wood, R. and Clearay, S (2013) Cost Effectiveness of Cryptococcal Antigen Screening as a Strategy to Prevent HIV-Associated Cryptococcal Meningitis in South Africa. PLoS ONE, 8, 1. http://dx.doi.org/10.1371/journal.pone.0069288
Abubakar, A.O., Maikai, B.V., Musa, B.O. and Olayinka, A.T. (2013) Public Health Implications of Cryptococcal Infection among HIV Patients on Antiretroviral Therapy in Hospital in Shika, Nigeria. ISDS 2013 Conference Abstracts.
Rugemalila, J., Maro, V.P., Kapanda, G., Ndaro, A.J. and Jarvis, J.N. (2013) Cryptococcal Antigen Prevalence in HIV-Infected Tanzanians: A Cross-Sectional Study and Evaluation of a Point-of-Care Lateral Flow Assay. Tropical Medicine & International Health, 18, 1075-1079. http://dx.doi.org/10.1111/tmi.12157
Igwegbe, A.O. and Ugboaja, J.O. (2010) Rate and Correlates of HIV Serostatus Disclosure among HIV Positive Pregnant Women in Nnewi Southeastern Nigeria. Journal of Medicine and Medical Science, 1, 296-301.
Meyer, A.C.L., Kendi, C.K., Penner, J.A., Odhiambo, N., Otieno, B., Omondi, E., Opiyo, E., Bukusi, E.A. and Cohen, C.R. (2013) The Impact of Routine Cryptococcal Antigen Screening on Survival among HIV-Infected Individuals with Advanced Immunosuppression in Kenya. Tropical Medicine and International Health, 18, 495-503. http://dx.doi.org/10.1111/tmi.12067
Andama, A.O., Saskia, B., Meya, D., Cattamanchi, A., Worodria, W., Davis, J.L., Walter, N.D., Samuel, D.Y., Kalema, N., Haller, B. and Huang, L. (2013) Prevalence and Outcomes of Cryptococcal Antigenemia in HIV-Seropositive Patients Hospitalized for Suspected Tuberculosis in Uganda. JAIDS, 63, 189-194. http://dx.doi.org/10.1097/QAI.0b013e3182926f95
Ganiem, A.R., Indrat, A.R., Wisaksana, R., Meijerink, H., Ven, A., Alisjahbana, B. and Crevel, R. (2014) Asymptomatic Cryptococcal Antigenemia Is Associated with Mortality among HIV-Positive Patients in Indonesia. JAIDS, 17, 18821.
Pongsai, P., Atamasirikul, K. and Sungkanuparph, S. (2010) The Role of Serum Cryptococcal Antigen Screening for the Early Diagnosis of Cryptococcosis in HIV-Infected Patients with Different Ranges of CD4 Cell Counts. Journal of Infection, 60, 474-477. http://dx.doi.org/10.1016/j.jinf.2010.03.015
Chukwuanukwu, R., Manafa, P., Iloghalu, E., Onyenekwe, C., Ifeanyichukwu, M. and Mbamalu, C. (2013) Cryptococcus Neoformans Antigenemia in HIV Positive Pregnant Women Attending a PMTCT Clinic in South-East Nigeria. Journal of Biology, Agriculture and Healthcare, 3, 15-20.
Pongsai, P., Atamasirikul, K. and Sungkanuparph, S. () The Role of Serum Cryptococcal Antigen Screening for the Early Diagnosis of Cryptococcosis in Asymptomatic HIV-Infected Patients. Proceedings of the 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention, Cape Town, 19-22 July 2009, Abstract No. TUPEB120.
Chim, B., Piseth, S.S., Heng, V.C., Sopheak, T. and Lynen, L. (2013) Integrated Cryptococcal Antigen Screening and Pre-Emptive Treatment Prior to Initiation of Antiretroviral Treatment in Cambodia. Journal of AIDS & Clinical Research, 4, 227. http://dx.doi.org/10.4172/2155-6113.1000227
Rajasingham, R., Meya, D.B. and Boulware, D.R. (2012) Integrating Cryptococcal Antigen Screening and Preemptive Treatment into Routine HIV Care. Journal of Acquired Immune Deficiency Syndromes, 59, 85-91. http://dx.doi.org/10.1097/QAI.0b013e31824c837e
Lawn, S.D., Myer, L., Harling, G., Orrell, C., Bekker, L.G. and Wood, R. (2006) Determinants of Mortality and Non Death Losses from an Antiretroviral Treatment Service in South Africa: Implications for Program Evaluation. Clinical Infectious Diseases, 43, 770-776. http://dx.doi.org/10.1086/507095