title: High prevalence of cryptococcal antigenaemia amongst asymptomatic advanced HIV patients in Pune, India.
abstract: BACKGROUND
  The World Health Organization recommends routine cryptococcal antigen (CrAg) screening in advanced AIDS patients initiating antiretroviral treatment (ART). India has yet to adopt this strategy as the burden of cryptococcal antigenaemia is unknown.
  
  
  METHODS
  A prospective study was conducted in a large public sector ART centre and the inpatient wards of Sassoon Hospital, Pune, India. All consenting patients> 18 years of age with CD4 count <100 cells/mm3 were screened for CrAg by latex agglutination assay. Those with positive CrAg underwent cerebrospinal fluid analysis, chest radiograph and abdominal ultrasound to rule out cryptococcal disease. The impact of CrAg positivity on all-cause mortality was assessed by logistic regression analysis.
  
  
  RESULTS
  Amongst 208 AIDS patients with CD4 cells <100 cells/mm3 who underwent CrAg testing, median age was 40 (interquartile range [IQR], 35-49) years, 134 (64%) were male and median CD4 count was 64.5 cells/mm3 (IQR, 37-82). Overall, 16 (8%, 95% confidence interval [CI], 4-12) patients were positive for CrAg, of which 8 (50%) had CD4 cells <50 cells/mm3 and 3 (19%) CrAg-positive patients had incidental cryptococcal meningitis. At 6-month follow-up, the case fatality rate was higher amongst CrAg-positive patients (38%) compared with CrAg-negative patients (18%) (P = 0.06). After adjusting for age, sex, CD4 count and ART, there was a trend towards increased all-cause mortality (adjusted OR, 3.18, 95% CI, 0.60-16.88,P= 0.17).
  
  
  CONCLUSIONS
  We found an 8% prevalence of cryptococcaemia amongst adult AIDS patients with CD4 cells <100 cells/mm3. Given the high fatality rates observed, routine screening for CrAg should be considered for all Indian persons with advanced HIV disease.
authors.affiliation: Department of Medicine, Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India.
authors.forename: Dileep
authors.initials: D
authors.lastname: Kadam
authors.affiliation: Department of Orthopedics, Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India.
authors.forename: Ajay
authors.initials: A
authors.lastname: Chandanwale
authors.affiliation: Department of Microbiology, Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India.
authors.forename: Renu
authors.initials: R
authors.lastname: Bharadwaj
authors.affiliation: Clinical Research Site, Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University, Pune, Maharashtra, India.
authors.forename: Neetal
authors.initials: N
authors.lastname: Nevrekar
authors.affiliation: Department of Otolaryngology, Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India.
authors.forename: Samir
authors.initials: S
authors.lastname: Joshi
authors.affiliation: Clinical Research Site, Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University, Pune, Maharashtra, India.
authors.forename: Sandesh
authors.initials: S
authors.lastname: Patil
authors.affiliation: Clinical Research Site, Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University, Pune, Maharashtra, India; Division of Infectious Diseases, Johns Hopkins University, Baltimore, USA.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Gupte
authors.affiliation: Department of Medicine, Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India.
authors.forename: Shashi
authors.initials: S
authors.lastname: Sangle
authors.affiliation: Clinical Research Site, Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University, Pune, Maharashtra, India.
authors.forename: Kavita
authors.initials: K
authors.lastname: Chopade
authors.affiliation: Clinical Research Site, Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University, Pune, Maharashtra, India.
authors.forename: Vandana
authors.initials: V
authors.lastname: Kulkarni
authors.affiliation: Clinical Research Site, Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University, Pune, Maharashtra, India.
authors.forename: Usha
authors.initials: U
authors.lastname: Balasubramanian
authors.affiliation: Clinical Research Site, Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University, Pune, Maharashtra, India.
authors.forename: Nishi
authors.initials: N
authors.lastname: Suryavanshi
authors.affiliation: Clinical Research Site, Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University, Pune, Maharashtra, India.
authors.forename: Divyashri
authors.initials: D
authors.lastname: Jain
authors.affiliation: Clinical Research Site, Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University, Pune, Maharashtra, India.
authors.forename: Savita
authors.initials: S
authors.lastname: Kanade
authors.affiliation: Department of Microbiology, Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India.
authors.forename: Sujata
authors.initials: S
authors.lastname: Dharmashale
authors.affiliation: Department of Microbiology, Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India.
authors.forename: Anju
authors.initials: A
authors.lastname: Kagal
authors.affiliation: Division of Infectious Diseases, Johns Hopkins University, Baltimore, USA.
authors.forename: Amita
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Clinical Research Site, Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University, Pune, Maharashtra, India; Division of Infectious Diseases, Johns Hopkins University, Baltimore, USA.
authors.forename: Vidya
authors.initials: V
authors.lastname: Mave
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000946:Antigens, Fungal / Q000097:blood*; D058070:Asymptomatic Diseases; D003453:Cryptococcosis / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D016469:Fungemia / Q000453:epidemiology* / Q000382:microbiology; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D000946:Antigens, Fungal