All Title Author
Keywords Abstract


Cryptococcal Antigenaemia among Treatment-Na?ve Adult HIV-Infected Nigerian Patients

DOI: 10.4236/wja.2016.61001, PP. 1-7

Keywords: HIV, Cryptococcal Antigen, Infected Adults, Nigeria

Full-Text   Cite this paper   Add to My Lib

Abstract:

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 infected patients.

References

[1]  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
[2]  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
[3]  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.
[4]  Jarvis, J.N. and Harrison, T.S. (2007) HIV-Associated Cryptococcal Meningitis. AIDS, 21, 2119-2129.
http://dx.doi.org/10.1097/QAD.0b013e3282a4a64d
[5]  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
[6]  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.
[7]  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
[8]  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
[9]  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
[10]  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
[11]  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
[12]  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
[13]  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
[14]  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
[15]  Federal Ministry of Health, Nigeria (2010) National Guidelines for HIV/AIDS Treatment and Care in Adolescents and Adults, 7-9.
[16]  Federal Ministry of Health (2010) National Guidelines for HIV and AIDS Treatment and Care, 1-10.
[17]  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.
[18]  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
[19]  CDC (2014) Prevalence and Correlates of Cryptococcal Antigen Positivity among AIDS Patients—United States, 1986-2012. Morbidity and Mortality Weekly Report (MMWR), 63, 585-587.
[20]  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.
[21]  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
[22]  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
[23]  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.
[24]  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
[25]  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.
[26]  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.
[27]  Mohammed, S.A. and Chandrasekhar, P. (2009) Study of Cryptococcal Meningitis in HIV Seropositive Patients in a Tertiary Care Centre. JIACM, 10, 110-115.
[28]  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
[29]  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
[30]  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

Full-Text

comments powered by Disqus