title: Prevalence of cryptococcal antigenuria at initial HIV diagnosis in KwaZulu-Natal.
abstract: OBJECTIVE
  The World Health Organization (WHO) recommends screening HIV-infected people for cryptococcal antigens to identify cryptococcosis, a major cause of AIDS-related deaths. As the burden of cryptococcosis is unknown in South Africa's KwaZulu-Natal province, we assessed the cryptococcal antigenuria prevalence among newly diagnosed HIV-infected adults there.
  
  
  METHODS
  We conducted a cross-sectional study of newly diagnosed HIV-infected adults who received voluntary HIV testing in an out-patient clinic. Participants provided a urine specimen in a sterile container, and we performed testing with a WHO-endorsed rapid cryptococcal antigen lateral flow assay (Immy Inc., Norman, OK, USA) per the manufacturer's specifications. We assessed cryptococcal antigenuria prevalence among participants with CD4 counts < 200 cells/μL, and stratified results by CD4 count categories.
  
  
  RESULTS
  Among 432 participants, the mean (± standard deviation) age was 36.1 ± 9.9 years and 172 (40%) were female. The overall estimated prevalence of cryptococcal antigenuria was 9.0% [95% confidence interval (CI) 6.5-12.1%]. CD4 counts were available for 319 participants (74%); the median CD4 count was 75 cells/μL [interquartile range (IQR) 34-129 cells/μL]. Participants with a negative cryptococcal antigenuria screening test had a median CD4 count of 79 cells/μL (IQR 36-129 cells/μL), while participants with a positive cryptococcal test had a median CD4 count of 41 cells/μL (IQR 10-112 cells/μL). The estimated prevalence of cryptococcal antigenuria among participants with CD4 counts < 50 cells/μL was 12.5% (95% CI 7.0-20.1%), which was significantly higher than that among participants with CD4 counts of 50-200 cells/μL (4.8%; 95% CI 2.3-8.7%).
  
  
  CONCLUSIONS
  Nearly 1 in 10 newly diagnosed HIV-infected adults with CD4 counts < 200 cells/μL in KwaZulu-Natal had evidence of cryptococcal antigenuria. Point-of-care CD4 count testing and cryptococcal antigen screening may rapidly identify cryptococcosis at the time of HIV diagnosis.
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA.
authors.forename: P K
authors.initials: PK
authors.lastname: Drain
authors.affiliation: Stony Brook School of Medicine, Stony Brook, NY, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Kleene
authors.affiliation: Boston University School of Public Health, Boston, MA, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Coleman
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: E
authors.initials: E
authors.lastname: Losina
authors.affiliation: Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: J N
authors.initials: JN
authors.lastname: Katz
authors.affiliation: McCord Hospital, Durban, South Africa.
authors.forename: J
authors.initials: J
authors.lastname: Giddy
authors.affiliation: St Mary's Hospital, Durban, South Africa.
authors.forename: D
authors.initials: D
authors.lastname: Ross
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Freedberg
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA.
authors.forename: I V
authors.initials: IV
authors.lastname: Bassett
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology*; D000328:Adult; D000946:Antigens, Fungal / Q000097:blood / Q000652:urine*; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D003453:Cryptococcosis / Q000175:diagnosis / Q000453:epidemiology* / Q000652:urine; D003454:Cryptococcus / Q000276:immunology / Q000302:isolation & purification*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology
chemical_list: D000946:Antigens, Fungal
keywords: CD4 count; HIV/AIDS; South Africa; cryptococcal urine antigen; cryptococcosis; cryptococcus; diagnosis