title: High prevalence of Cryptococcal antigenemia among HIV-infected patients receiving antiretroviral therapy in Ethiopia.
abstract: BACKGROUND
  Cryptococcal disease is estimated to be responsible for significant mortality in Sub-Saharan Africa; however, only scarce epidemiology data exists. We sought to evaluate the prevalence of and risk factors for cryptococcal antigenemia in Ethiopia.
  
  
  METHODS
  Consecutive adult HIV-infected patients from two public HIV clinics in Addis Ababa, Ethiopia were enrolled into the study. A CD4 count ≤ 200 cells/μl was required for study participation. Patients receiving anti-retroviral therapy (ART) were not excluded. A cryptococcal antigen test was performed for all patients along with an interview, physical exam, and medical chart abstraction. Logistic regression analysis was used to assess risk factors for cryptococcal antigenemia.
  
  
  RESULTS
  369 HIV-infected patients were enrolled; mean CD4 123 cells/μl and 74% receiving ART. The overall prevalence of cryptococcal antigenemia was 8.4%; 11% in patients with a CD4 count <100 cells/μl, 8.9% with CD4 100 to 150 cells/μl and 5.7% with CD4150-200 cell/μl. 84% of patients with cryptococcal antigenemia were receiving ART. In multivariable analysis, increasing age, self reported fever, CD4 count <100 cells/μl, and site of screening were associated with an increased risk of cryptococcal antigenemia. No individual or combination of clinical symptoms had optimal sensitivity or specificity for cryptococcal antigenemia.
  
  
  CONCLUSIONS
  Cryptococcal antigenemia is high in Ethiopia and rapid scale up of screening programs is needed. Screening should be implemented for HIV-infected patients with low CD4 counts regardless of symptoms or receipt of ART. Further study into the effect of location and environment on cryptococcal disease is warranted.
authors.affiliation: Haramya University, Medical Laboratory Technology, Harar, Ethiopia.
authors.forename: Abere Shiferaw
authors.initials: AS
authors.lastname: Alemu
authors.forename: Russell R
authors.initials: RR
authors.lastname: Kempker
authors.forename: Admasu
authors.initials: A
authors.lastname: Tenna
authors.forename: Christopher
authors.initials: C
authors.lastname: Smitson
authors.forename: Nega
authors.initials: N
authors.lastname: Berhe
authors.forename: Daniel
authors.initials: D
authors.lastname: Fekade
authors.forename: Henry M
authors.initials: HM
authors.lastname: Blumberg
authors.forename: Abraham
authors.initials: A
authors.lastname: Aseffa
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000494:pharmacology / Q000627:therapeutic use; D000946:Antigens, Fungal / Q000097:blood / Q000276:immunology*; D018791:CD4 Lymphocyte Count; D015897:Comorbidity; D003454:Cryptococcus / Q000276:immunology* / Q000302:isolation & purification; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology / Q000821:virology*; D006801:Humans; D008297:Male; D016919:Meningitis, Cryptococcal / Q000175:diagnosis* / Q000453:epidemiology* / Q000276:immunology / Q000382:microbiology; D015999:Multivariate Analysis; D015995:Prevalence; D012307:Risk Factors
chemical_list: D019380:Anti-HIV Agents; D000946:Antigens, Fungal