title: Asymptomatic cryptococcal antigen prevalence detected by lateral flow assay in hospitalised HIV-infected patients in São Paulo, Brazil.
abstract: To determine the prevalence of asymptomatic cryptococcal antigen (CRAG) using lateral flow assay (LFA) in hospitalised HIV-infected patients with CD4 counts <200 cells/μl.
  
  
  
  Hospitalised HIV-infected patients were prospectively recruited at Instituto de Infectologia Emilio Ribas, a tertiary referral hospital to HIV-infected patients serving the São Paulo State, Brazil. All patients were >18 years old without prior cryptococcal meningitis, without clinical suspicion of cryptococcal meningitis, regardless of antiretroviral (ART) status, and with CD4 counts <200 cells/μl. Serum CRAG was tested by LFA in all patients, and whole blood CRAG was tested by LFA in positive cases.
  
  
  
  We enrolled 163 participants of whom 61% were men. The duration of HIV diagnosis was a median of 8 (range, 1-29) years. 26% were antiretroviral (ART)-naïve, and 74% were ART-experienced. The median CD4 cell count was 25 (range, 1-192) cells/μl. Five patients (3.1%; 95%CI, 1.0-7.0%) were asymptomatic CRAG-positive. Positive results cases were cross-verified by performing LFA in whole blood.
  
  
  
  3.1% of HIV-infected inpatients with CD4 <200 cells/μl without symptomatic meningitis had cryptococcal antigenemia in São Paulo, suggesting that routine CRAG screening may be beneficial in similar settings in South America. Our study reveals another targeted population for CRAG screening: hospitalised HIV-infected patients with CD4 <200 cells/μl, regardless of ART status. Whole blood CRAG LFA screening seems to be a simple strategy to prevention of symptomatic meningitis.
authors.affiliation: Instituto de Infectologia Emilio Ribas, São Paulo, Brazil.|Faculdade de Medicina, Hospital das Clínicas, da Universidade de São Paulo, São Paulo, Brazil.|Instituto de Medicina Tropical da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: José E
authors.initials: JE
authors.lastname: Vidal
authors.affiliation: Instituto de Infectologia Emilio Ribas, São Paulo, Brazil.
authors.forename: Carolina
authors.initials: C
authors.lastname: Toniolo
authors.affiliation: Instituto de Infectologia Emilio Ribas, São Paulo, Brazil.
authors.forename: Adriana
authors.initials: A
authors.lastname: Paulino
authors.affiliation: Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Arnaldo
authors.initials: A
authors.lastname: Colombo
authors.affiliation: Instituto Adolfo Lutz, São Paulo, Brazil.
authors.forename: Marilena
authors.initials: M
authors.lastname: Dos Anjos Martins
authors.affiliation: Instituto Adolfo Lutz, São Paulo, Brazil.
authors.forename: Cristina
authors.initials: C
authors.lastname: da Silva Meira
authors.affiliation: Instituto Adolfo Lutz, São Paulo, Brazil.
authors.forename: Vera Lucia
authors.initials: VL
authors.lastname: Pereira-Chioccola
authors.affiliation: Instituto de Infectologia Emilio Ribas, São Paulo, Brazil.|Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil.
authors.forename: Claudia
authors.initials: C
authors.lastname: Figueiredo-Mello
authors.affiliation: Instituto de Infectologia Emilio Ribas, São Paulo, Brazil.
authors.forename: Tiago
authors.initials: T
authors.lastname: Barros
authors.affiliation: Instituto de Infectologia Emilio Ribas, São Paulo, Brazil.
authors.forename: Jequelie
authors.initials: J
authors.lastname: Duarte
authors.affiliation: Instituto de Infectologia Emilio Ribas, São Paulo, Brazil.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Fonseca
authors.affiliation: Instituto de Infectologia Emilio Ribas, São Paulo, Brazil.
authors.forename: Mirella
authors.initials: M
authors.lastname: Alves Cunha
authors.affiliation: Instituto de Infectologia Emilio Ribas, São Paulo, Brazil.
authors.forename: Clara
authors.initials: C
authors.lastname: Mendes
authors.affiliation: Instituto de Infectologia Emilio Ribas, São Paulo, Brazil.
authors.forename: Taiana
authors.initials: T
authors.lastname: Ribero
authors.affiliation: Instituto Nacional de Doenças Infecciosas, Fundação Fiocruz, Rio de Janeiro, Brazil.
authors.forename: Marcia
authors.initials: M
authors.lastname: Dos Santos Lazera
authors.affiliation: University of Minnesota, Minneapolis, MN, USA.
authors.forename: Radha
authors.initials: R
authors.lastname: Rajasingham
authors.affiliation: University of Minnesota, Minneapolis, MN, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Boulware
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology*; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000946:Antigens, Fungal / Q000097:blood*; D001938:Brazil / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D003454:Cryptococcus / Q000276:immunology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006760:Hospitalization; D006801:Humans; D007118:Immunoassay / Q000379:methods; D008297:Male; D016919:Meningitis, Cryptococcal / Q000175:diagnosis / Q000453:epidemiology*; D008875:Middle Aged; D015995:Prevalence
chemical_list: D019380:Anti-HIV Agents; D000946:Antigens, Fungal
keywords: Criptococo; Cryptococcus; HIV/AIDS; VIH/SIDA; cribado criptocócico; cryptococcal meningitis; cryptococcal polysaccharide; cryptococcal screening; dépistage cryptococcique; meningitis criptocócica; méningite cryptococcique; polisacárido criptocócico; polysaccharide cryptococcique; prevalence; prevalencia; prévalence