title: Comparison of cryptococcal antigenemia between antiretroviral naïve and antiretroviral experienced HIV positive patients at two hospitals in Ethiopia.
abstract: BACKGROUND
  Cryptococcal meningitis is a major cause of HIV/AIDS-related deaths in Africa. Cryptococcosis is a neglected killer. However, meningitis can be prevented by early cryptococcal antigen (CrAg) screening and preemptive antifungal treatment during a prolonged period of detectable, subclinical infection. We determined the prevalence of cryptococcal antigenemia in comparison to CD4 count and clinical symptoms.
  
  
  METHODS
  We surveyed 254 consenting HIV-infected participants to obtain demographic information and clinical history. Serum CrAg was measured by latex agglutination at two sites in the Oromia region of Ethiopia among all persons receiving a CD4 count.
  
  
  RESULTS
  Of the 254 participants, 127(50.0%) were ART-naïve, 121(47.6%) were ART-experienced, and 6(2.4%) were ART-defaulters. The prevalence of cryptococcal antigenemia was 10.2% overall being 14.2% among ART-naive, 4.1% among ART-experienced, and 50% (3/6) among ART-defaulters, irrespective of CD4 count. Cryptococcal antigenemia was more frequently detected from ART-naïve patients (p = 0.012) and ART-defaulters (p = 0.001) compared with ART-experienced. Serum CrAg positivity was 20.9% in persons with CD4≤150 cells/µL, 12.2% in 151-200 cells/µL, 5.8% among 201-350 CD4/µL, and none above 350 cells/µL. Potential meningitis symptoms were common in the outpatient cohort irrespective of CrAg-status, with only fever and altered mental status statistically more common in CrAg-positive compared to CrAg-negative persons (P<0.05), yet no symptom had a positive predictive value >33%.
  
  
  CONCLUSIONS
  We report a 20.9% cryptococcal antigenemia prevalence among those with CD4+ T cells count ≤150 cells/µL, irrespective of ART status, with even higher CrAg prevalence in ART-naïves and ART-defaulters. These groups are target populations for CrAg screening at entry into HIV care.
authors.affiliation: Department of Biomedical Sciences; Asella School of Health Sciences, Adama Science and Technology University, Asella, Ethiopia.
authors.forename: Tafese
authors.initials: T
authors.lastname: Beyene
authors.forename: Yimtubezinash
authors.initials: Y
authors.lastname: Woldeamanuel
authors.forename: Daniel
authors.initials: D
authors.lastname: Asrat
authors.forename: Gonfa
authors.initials: G
authors.lastname: Ayana
authors.forename: David R
authors.initials: DR
authors.lastname: Boulware
mesh_terms: D000293:Adolescent; D000328:Adult; D000946:Antigens, Fungal / Q000097:blood*; D015496:CD4-Positive T-Lymphocytes / Q000378:metabolism; D003454:Cryptococcus / Q000276:immunology*; D005002:Ethiopia; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D000946:Antigens, Fungal