Cryptococcal infection in a cohort of HIV-1-infected Ugandan adults.
OBJECTIVE
Despite the recognition of Cryptococcus neoformans as a major cause of meningitis in HIV-infected adults in sub-Saharan Africa, little is known about the relative importance of this potentially preventable infection as a cause of mortality and suffering in HIV-infected adults in this region.


METHODS
A cohort study of 1372 HIV-1-infected adults, enrolled and followed up between October 1995 and January 1999 at two community clinics in Entebbe, Uganda.


METHODS
Systematic and standardized assessment of illness episodes to describe cryptococcal disease and death rates.


RESULTS
Cryptococcal disease was diagnosed in 77 individuals (rate 40.4/1000 person-years) and was associated with 17% of all deaths (77 out of 444) in the cohort. Risk of infection was strongly associated with CD4 T cell counts < 200 x 10(6) cells/l(75 patients) and World Health Organization (WHO) clinical stage 3 and 4 (68 patients). Meningism was present infrequently on presentation (18%). Clinical findings had limited discriminatory diagnostic value. Serum cryptococcal antigen testing was the most sensitive and robust diagnostic test. Cryptococcal antigenaemia preceded symptoms by a median of 22 days (> 100 days in 11% of patients). Survival following diagnosis was poor (median survival 26 days; range 0-138).


CONCLUSIONS
Cryptococcal infection is an important contributor to mortality and suffering in HIV-infected Ugandans. Improvements in access to effective therapy of established disease are necessary. In addition, prevention strategies, in particular chemoprophylaxis, should be evaluated while awaiting the outcome of initiatives to make antiretroviral therapy more widely available.
French
Neil
N
Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK.
Gray
Katherine
K
Watera
Christine
C
Nakiyingi
Jessica
J
Lugada
Eric
E
Moore
Michael
M
Lalloo
David
D
Whitworth
James A G
JA
Gilks
Charles F
CF
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000946:Antigens, Fungal / Q000097:blood; D015331:Cohort Studies; D003453:Cryptococcosis / Q000453:epidemiology* / Q000209:etiology; D003455:Cryptococcus neoformans / Q000276:immunology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D016919:Meningitis, Cryptococcal / Q000453:epidemiology / Q000209:etiology; D008875:Middle Aged; D022242:Pneumococcal Vaccines; D016032:Randomized Controlled Trials as Topic; D016036:Seroepidemiologic Studies; D016019:Survival Analysis; D014454:Uganda / Q000453:epidemiology
D000946:Antigens, Fungal; D022242:Pneumococcal Vaccines