Prevalence, determinants of positivity, and clinical utility of cryptococcal antigenemia in Cambodian HIV-infected patients.
OBJECTIVE
To determine the prevalence, determinants ofpositivity, and clinical utility of serum cryptococcal polysaccharide (CPS) antigen testing among HIV-infected patients in 2004 in Cambodia, an area highly endemic for cryptococcosis.


METHODS
All HIV-infected patients with a CD4+ count <200 cells/mm3 attending 1 of 2 Phnom Penh hospitals for the first time were systematically screened for serum CPS. Patients with positive test results were further investigated to identify those with cryptococcal meningitis (CM), pulmonary cryptococcosis, or isolated positive cryptococcal antigenemia (IPCA).


RESULTS
The median (interquartile range [IQR]) CD4+ count of 327 enrolled patients was 24 (IQR: 8 to 65) cells/mm3. The prevalence of cryptococcal infection was 59 (18.0%) of 327 cases, of which 41 were CM and 10 were IPCA. In the absence of serum CPS detection, 17 (28.8%) of 59 cryptococcal infections would have been missed on the day of consultation. In patients with no specific symptoms of meningoencephalitis, the prevalence of positive serum CPS detection was 32 (10.8%) of 295 cases. Countryside residence (adjusted odds ratio [AOR] = 3.6), headache (AOR = 3.2), body mass index <15.4 kg/m2 (AOR = 3.4), CD4+ count <50 cells/mm3 (AOR = 4.0), and male gender (marginally, AOR = 2.1) were all independently associated with a positive test results.


CONCLUSIONS
Serum CPS screening among AIDS patients with a CD4+ count <100 cells/mm3 is useful in areas highly endemic for cryptococcosis, allowing early diagnosis and treatment of this opportunistic infection.
Micol
Romain
R
Unité d'Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France. romain.micol@nck.aphp.fr
Lortholary
Olivier
O
Sar
Borann
B
Laureillard
Didier
D
Ngeth
ChanChhaya
C
Dousset
Jean-Philippe
JP
Chanroeun
Hak
H
Ferradini
Laurent
L
Guerin
Philippe Jean
PJ
Dromer
Françoise
F
Fontanet
Arnaud
A
D017088:AIDS-Related Opportunistic Infections / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D000328:Adult; D000946:Antigens, Fungal / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D018791:CD4 Lymphocyte Count; D002160:Cambodia / Q000453:epidemiology; D015331:Cohort Studies; D003453:Cryptococcosis / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D003455:Cryptococcus neoformans / Q000276:immunology* / Q000302:isolation & purification; D003937:Diagnosis, Differential; D005260:Female; D006678:HIV; D006261:Headache / Q000473:pathology; D006801:Humans; D008297:Male; D016919:Meningitis, Cryptococcal / Q000097:blood / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors
D000946:Antigens, Fungal; D015415:Biomarkers