title: Brief Report: Geographical Variation in Prevalence of Cryptococcal Antigenemia Among HIV-Infected, Treatment-Naive Patients in Nigeria: A Multicenter Cross-Sectional Study.
abstract: Worldwide, HIV-associated cryptococcal meningitis affects approximately 1 million persons and causes 600,000 deaths each year mostly in sub-Saharan Africa. Limited data exist on cryptococcal meningitis and antigenemia in Nigeria, and most studies are geographically restricted. We determined the prevalence of cryptococcal antigenemia (CrAg) among HIV-infected, treatment-naive individuals in Nigeria.
  
  
  
  This was a retrospective, cross-sectional study across 4 geographic regions in Nigeria. We performed CrAg testing using a lateral flow immunoassay on archived whole-blood samples collected from HIV-infected participants at US President's Emergency Plan for AIDS Relief (PEPFAR)-supported sites selected to represent the major geographical and ethnic diversity in Nigeria. Eligible samples were collected from consenting patients (>15 years) naive to antiretroviral therapy with CD4 count less than 200 cells per cubic millimeter and were stored in an -80°C freezer.
  
  
  
  A total of 2752 stored blood samples were retrospectively screened for CrAg. Most of the samples were from participants aged 30-44 years (57.6%), and 1570 (57.1%) were from women. The prevalence of CrAg positivity in specimens with CD4 <200 cells per cubic millimeter was 2.3% (95% confidence interval: 1.8% to 3.0%) and varied significantly across the 4 regions (P < 0.001). At 4.4% (3.2% to 5.9%), the South East contained the highest prevalence.
  
  
  
  The significant regional variation in CrAg prevalence found in Nigeria should be taken into consideration as plans are made to integrate routine screening into clinical care for HIV-infected patients.
authors.affiliation: *Global Health Initiative, School of Community Health Sciences, University of Nevada Las Vegas, Las Vegas, NV; †Department of Pediatrics, University of Nevada School of Medicine, Las Vegas, NV; ‡Centre for Clinical Care and Clinical Research, Nigeria (CCCRN), Abuja, Nigeria; §Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA; ‖Nigerian Army Reference Hospital, Lagos, Nigeria; ¶Department of Medicine, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria; #Institute of Human Virology Nigeria, Abuja, Nigeria; and **Department of Microbiology and Immunology, University of Nevada School of Medicine, Reno, NV.
authors.forename: Echezona E
authors.initials: EE
authors.lastname: Ezeanolue
authors.forename: Chidi
authors.initials: C
authors.lastname: Nwizu
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Greene
authors.forename: Olatilewa
authors.initials: O
authors.lastname: Amusu
authors.forename: Chinwe
authors.initials: C
authors.lastname: Chukwuka
authors.forename: Nicaise
authors.initials: N
authors.lastname: Ndembi
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Smith
authors.forename: Tom
authors.initials: T
authors.lastname: Chiller
authors.forename: Jennifer
authors.initials: J
authors.lastname: Pharr
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Kozel
mesh_terms: D000946:Antigens, Fungal / Q000097:blood*; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D003455:Cryptococcus neoformans / Q000276:immunology*; D005843:Geography; D015658:HIV Infections / Q000276:immunology*; D006801:Humans; D009549:Nigeria; D015995:Prevalence; D012189:Retrospective Studies
chemical_list: D000946:Antigens, Fungal