We have located links that may give you full text access.
Cryptococcal Antigenemia in HIV therapy-experienced Ugandans with Virologic Failure.
Clinical Infectious Diseases 2019 November 4
BACKGROUND: Detectable serum or plasma cryptococcal antigen (CrAg) precedes symptomatic cryptococcal meningitis. The World Health Organization (WHO) recommends CrAg screening for HIV infected people with CD4<100 cells/mcL initiating antiretroviral therapy (ART). However, an increasing proportion of cryptococcosis patients are now ART-experienced. Whether CrAg screening is cost-effective in those with virologic failure is unknown.
METHODS: We retrospectively performed nationwide plasma CrAg testing among ART experienced Ugandan adults with virologic failure (≥1,000 copies/mL) using leftover plasma after viral load testing during September 2017-January 2018. For those CrAg-positive, we obtained ART history, meningitis occurrence, and 6-month survival via medical record review.
RESULTS: Among 1,186 subjects with virologic failure, 35 (3.0%) were CrAg-positive with median ART duration of 41 months (IQR, 10-84 months). Among 25 subjects with 6-month outcomes, 16 (64%) survived, 7 (28%) died, and 2 (8%) were lost. One survivor had suffered cryptococcal meningitis two years prior. Two others developed cryptococcal meningitis and survived. Five survivors were known to have received fluconazole. Thus, meningitis-free survival at 6-months was 61% (14/23). Overall, 91% (32/35) of CrAg-positive persons had viral load ≥5000 copies/mL compared with 64% (735/1,151) of CrAg-negative (Odds Ratio = 6.0; 95% CI: 1.8-19.8, P = 0.001). CrAg prevalence was 4.2% (32/768) among those with viral loads ≥5000 copies/mL and 0.7% (3/419) among <5000 copies/mL.
CONCLUSION: In addition to the CD4 threshold of <100 cells/mcL, reflexive CrAg screening should be considered in persons failing ART in Uganda with viral loads ≥5000 copies/mL.
METHODS: We retrospectively performed nationwide plasma CrAg testing among ART experienced Ugandan adults with virologic failure (≥1,000 copies/mL) using leftover plasma after viral load testing during September 2017-January 2018. For those CrAg-positive, we obtained ART history, meningitis occurrence, and 6-month survival via medical record review.
RESULTS: Among 1,186 subjects with virologic failure, 35 (3.0%) were CrAg-positive with median ART duration of 41 months (IQR, 10-84 months). Among 25 subjects with 6-month outcomes, 16 (64%) survived, 7 (28%) died, and 2 (8%) were lost. One survivor had suffered cryptococcal meningitis two years prior. Two others developed cryptococcal meningitis and survived. Five survivors were known to have received fluconazole. Thus, meningitis-free survival at 6-months was 61% (14/23). Overall, 91% (32/35) of CrAg-positive persons had viral load ≥5000 copies/mL compared with 64% (735/1,151) of CrAg-negative (Odds Ratio = 6.0; 95% CI: 1.8-19.8, P = 0.001). CrAg prevalence was 4.2% (32/768) among those with viral loads ≥5000 copies/mL and 0.7% (3/419) among <5000 copies/mL.
CONCLUSION: In addition to the CD4 threshold of <100 cells/mcL, reflexive CrAg screening should be considered in persons failing ART in Uganda with viral loads ≥5000 copies/mL.
Full text links
Related Resources
Trending Papers
Challenges in Septic Shock: From New Hemodynamics to Blood Purification Therapies.Journal of Personalized Medicine 2024 Februrary 4
Molecular Targets of Novel Therapeutics for Diabetic Kidney Disease: A New Era of Nephroprotection.International Journal of Molecular Sciences 2024 April 4
Perioperative echocardiographic strain analysis: what anesthesiologists should know.Canadian Journal of Anaesthesia 2024 April 11
The 'Ten Commandments' for the 2023 European Society of Cardiology guidelines for the management of endocarditis.European Heart Journal 2024 April 18
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app