Cryptococcal antigen prevalence in HIV patients from a tertiary care centre in South India
,
Abstract
Background and Objectives: Cryptococcosis is an opportunistic mycosis, caused by Cryptococcus neoformans. Cryptococcal meningitis is one of the most fatal opportunistic infections associated with human immunodeficiency virus (HIV) infection. The aim of this study was to find the prevalence of cryptococcal antigenemia in people living with HIV (PLHA) and also to find the prevalence of opportunistic infections among these patients.
Materials and Methods: A total of 204 non duplicate samples were collected from people with HIV aged above 18 years. Samples with CD4 count less than 300 were included in the study. Cryptococcal antigen detection was done by CrAg Lateral flow assay.
Results: None of the patients in our study were positive for cryptococcal antigen. Opportunistic infections were observed in 82 (40.2%) HIV positive patients. Candidiasis, tuberculosis and Pneumocystis jiroveci pneumonia were the most common opportunistic infections.
Conclusion: This is the first study from the southern state of Kerala on the prevalence of Cryptococcal antigenemia among HIV positive individuals. The study showed that routine screening for cryptococcal antigen will not be cost effective in our population. Similar to other studies, eventhough candidiasis, tuberculosis and PCP were more commonly seen among people with CD4 count < 200 cells/mm3, there was no statistically significant association.
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14. Liechty CA, Solberg P, Were W, Ekwaru JP, Ransom RL, Weidle PJ, et al. Asymptomatic serum cryptococcal antigenemia and early mortality during antiretroviral therapy in rural Uganda. Trop Med Int Health 2007; 12: 929-935.
15. Micol R, Lortholary O, Sar B, Laureillard D, Ngeth C, Dousset J-P, et al. Prevalence, determinants of positivity, and clinical utility of cryptococcal antigenemia in Cambodian HIV-infected patients. J Acquir Immune Defic Syndr 2007; 45: 555-559.
16. Jemal M, Deress T, Belachew T, Adem Y. Prevalence of cryptococcal antigenemia and associated factors among HIV/AIDS Patients at Felege-Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia. Int J Microbiol 2021; 2021: 8839238.
17. Kadam D, Chandanwale A, Bharadwaj R, Nevrekar N, Joshi S, Patil S, et al. High prevalence of cryptococcal antigenaemia amongst asymptomatic advanced HIV patients in Pune, India. Indian J Med Microbiol 2017; 35: 105-108.
18. Tapia C, Gonzalez P, Pereira A, Pérez J, Noriega LM, Palavecino E. Antifungal susceptibility testing of Candida albicans isolates from AIDS patients with oropharyngeal and esophageal candidiasis: Experience with Etest. Rev Med Chil 2003; 131: 515-519.
19. Brooks JT, Kaplan JE, Masur H. What’s new in the 2009 US Guidelines for prevention and treatment of opportunistic infections among adults and adolescents with HIV. Top HIV Med 2009; 17: 109-114.
20. Crothers K, Thompson BW, Burkhardt K, Morris A, Flores SC, Diaz PT, et al. HIV-associated lung infections and complications in the era of combination antiretroviral therapy. Proc Am Thorac Soc 2011; 8: 275-281.
21. Udwadia ZF, Doshi AV, Bhaduri AS. Pneumocystis carinii pneumonia in HIV infected patients from Mumbai. J Assoc Physicians India 2005; 53: 437-440.
22. Vinod PK, Radhakrishnan C, Pk S. Incidence and spectrum of opportunistic infections among HIV infected patients attending government medical college, Kozhikode. J Assoc Physicians India 2018; 66: 33-36.
23. Rajasingham R, Meya DB, Boulware DR. Integrating Cryptococcal Antigen Screening and PreemptiveTreatment into Routine HIV care. J Acquir Immune Defic Syndr 2012; 59(5): e85-91.
24. Ayats J, Martín-Mazuelos E, Pemán J, Quindós G, Sánchez F, García-Rodríguez J, et al. Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC) guidelines for the diagnosis of invasive fungal infections. 2010 update. Enferm Infecc Microbiol Clin 2011; 29(1): 39.e1-15.
25. World Health Organization (WHO). Rapid advice: Diagnosis, prevention and management of cryptococcal disease in HIV‑infected adults, adolescents and children: December 2011. World Health Organization. https://apps.who.int/iris/handle/10665/44786
26. Gupta A, Nadkarni G, Yang W-T, Chandrasekhar A, Gupte N, Bisson GP, et al. Early mortality in adults initiating antiretroviral therapy (ART) in low‑.and middle‑income countries (LMIC): A systematic review and meta‑analysis. PLoS One 2011; 6(12): e28691.
27. Meya DB, Manabe YC, Castelnuovo B, Cook BA, Elbireer AM, Kambugu A, et al. Cost-effectiveness of serum cryptococcal antigen screening to prevent deaths among HIV-infected persons with a CD4+ cell count ≤ or =100 cells/microl who start HIV therapy in resource- limited settings. Clin Infect Dis 2010; 51: 448-455.
2. Dash M, Padhi S, Sahu R, Turuk J, Pattanaik S, Misra P. Prevalence of cryptococcal meningitis among people living with human immunodeficiency virus/acquired immunodeficiency syndrome in a Tertiary Care Hospital, Southern Odisha, India. J Nat Sci Biol Med 2014; 5: 324-328.
3. Roy M, Chiller T. Preventing deaths from Cryptococcal meningitis: From bench to bedside. Expert Rev Anti Infect Ther 2011; 9: 715-717.
4. Okwir M, Link A, Rhein J, Obbo JS, Okello J, Nabongo B, et al. High burden of cryptococcal meningitis among antiretroviral therapy-experienced human immunodeficiency virus-infected patients in Northern Uganda in the era of "Test and Treat": Implications for cryptococcal screening programs. Open Forum Infect Dis 2022; 9: ofac004.
5. Escandón P, Lizarazo J, Agudelo CI, Chiller T, Castañeda E. Evaluation of a rapid lateral flow immunoassay for the detection of cryptococcal antigen for the early diagnosis of cryptococcosis in HIV patients in Colombia. Med Mycol 2013; 51: 765-768.
6. Calmy A, Klement E, Teck R, Berman D, Pecoul B, Ferradini L. Simplifying and adapting antiretroviral treatment in resource-poor settings: a necessary step to scaling-up. AIDS 2004; 18: 2353-2360.
7. Perfect JR, Dismukes WE, Dromer F, Goldman DL, Graybill JR, Hamill RJ, et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of America. Clin Infect Dis 2010; 50: 291-322.
8. Jarvis JN, Percival A, Bauman S, Pelfrey J, Meintjes G, Williams GN, et al. Evaluation of a novel point-of-care cryptococcal antigen test on serum, plasma, and urine from patients with HIV-associated cryptococcal meningitis. Clin Infect Dis 2011; 53: 1019-1023.
9. Park BJ, Wannemuehler KA, Marston BJ, Govender N, Pappas PG, Chiller TM. Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS. AIDS 2009; 23: 525-530.
10. Hajiabdolbaghi M, Kalantari S, Jamshidi-Makiani M, Shojaei E, Abbasian L, Rasoulinezhad M, et al. Prevalence of cryptococcal antigen positivity among HIV infected patient with CD4 cell count less than 100 of Imam Khomeini Hospital, Tehran, Iran. Iran J Microbiol 2017; 9: 119-121.
11. Smith RM, Nguyen TA, Ha HTT, Thang PH, Thuy C, Lien TX, et al. Prevalence of cryptococcal antigenemia and cost‑effectiveness of a cryptococcal antigen screening program – Vietnam. PLoS One 2013; 8(4): e62213.
12. McKenney J, Smith RM, Chiller TM, Detels R, French A, Margolick J, et al. Prevalence and correlates of cryptococcal antigen positivity amongAIDS patients – United States, 1986‑2012. MMWR Morb Mortal Wkly Rep 2014; 63: 585‑587.
13. Ezenabike C, S Ashaka O, A Omoare A, Fadeyi A, K Salami A, O Agbede O. Cryptococcal antigen among HIV1-infected individuals in north-central Nigeria. Curr Med Mycol 2020; 6: 43-48.
14. Liechty CA, Solberg P, Were W, Ekwaru JP, Ransom RL, Weidle PJ, et al. Asymptomatic serum cryptococcal antigenemia and early mortality during antiretroviral therapy in rural Uganda. Trop Med Int Health 2007; 12: 929-935.
15. Micol R, Lortholary O, Sar B, Laureillard D, Ngeth C, Dousset J-P, et al. Prevalence, determinants of positivity, and clinical utility of cryptococcal antigenemia in Cambodian HIV-infected patients. J Acquir Immune Defic Syndr 2007; 45: 555-559.
16. Jemal M, Deress T, Belachew T, Adem Y. Prevalence of cryptococcal antigenemia and associated factors among HIV/AIDS Patients at Felege-Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia. Int J Microbiol 2021; 2021: 8839238.
17. Kadam D, Chandanwale A, Bharadwaj R, Nevrekar N, Joshi S, Patil S, et al. High prevalence of cryptococcal antigenaemia amongst asymptomatic advanced HIV patients in Pune, India. Indian J Med Microbiol 2017; 35: 105-108.
18. Tapia C, Gonzalez P, Pereira A, Pérez J, Noriega LM, Palavecino E. Antifungal susceptibility testing of Candida albicans isolates from AIDS patients with oropharyngeal and esophageal candidiasis: Experience with Etest. Rev Med Chil 2003; 131: 515-519.
19. Brooks JT, Kaplan JE, Masur H. What’s new in the 2009 US Guidelines for prevention and treatment of opportunistic infections among adults and adolescents with HIV. Top HIV Med 2009; 17: 109-114.
20. Crothers K, Thompson BW, Burkhardt K, Morris A, Flores SC, Diaz PT, et al. HIV-associated lung infections and complications in the era of combination antiretroviral therapy. Proc Am Thorac Soc 2011; 8: 275-281.
21. Udwadia ZF, Doshi AV, Bhaduri AS. Pneumocystis carinii pneumonia in HIV infected patients from Mumbai. J Assoc Physicians India 2005; 53: 437-440.
22. Vinod PK, Radhakrishnan C, Pk S. Incidence and spectrum of opportunistic infections among HIV infected patients attending government medical college, Kozhikode. J Assoc Physicians India 2018; 66: 33-36.
23. Rajasingham R, Meya DB, Boulware DR. Integrating Cryptococcal Antigen Screening and PreemptiveTreatment into Routine HIV care. J Acquir Immune Defic Syndr 2012; 59(5): e85-91.
24. Ayats J, Martín-Mazuelos E, Pemán J, Quindós G, Sánchez F, García-Rodríguez J, et al. Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC) guidelines for the diagnosis of invasive fungal infections. 2010 update. Enferm Infecc Microbiol Clin 2011; 29(1): 39.e1-15.
25. World Health Organization (WHO). Rapid advice: Diagnosis, prevention and management of cryptococcal disease in HIV‑infected adults, adolescents and children: December 2011. World Health Organization. https://apps.who.int/iris/handle/10665/44786
26. Gupta A, Nadkarni G, Yang W-T, Chandrasekhar A, Gupte N, Bisson GP, et al. Early mortality in adults initiating antiretroviral therapy (ART) in low‑.and middle‑income countries (LMIC): A systematic review and meta‑analysis. PLoS One 2011; 6(12): e28691.
27. Meya DB, Manabe YC, Castelnuovo B, Cook BA, Elbireer AM, Kambugu A, et al. Cost-effectiveness of serum cryptococcal antigen screening to prevent deaths among HIV-infected persons with a CD4+ cell count ≤ or =100 cells/microl who start HIV therapy in resource- limited settings. Clin Infect Dis 2010; 51: 448-455.
| Files | ||
| Issue | Vol 14 No 5 (2022) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijm.v14i5.10970 | |
| Keywords | ||
| Cryptococcosis; Toxoplasmosis; Opportunistic infections; Tuberculosis; Candidiasis | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Madhavan A, Sachu A, Samuel A, Vasudevapanicker J. Cryptococcal antigen prevalence in HIV patients from a tertiary care centre in South India. Iran J Microbiol. 2022;14(5):740-745.
