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Cryptococcal Antigenaemia among Treatment-Naive Adult HIV-Infected Nigerian Patients


Affiliations
1 Antiretroviral Therapy Clinic, Haematology Department, Lagos State University Teaching Hospital, Lagos, Nigeria
 

Background: There is a high burden of HIV-related cryptococcal meningitis in Sub-Saharan Africa and it is a leading cause of morbidity and early mortality among severely immunocompromised patients. Objectives of the Study: This study was carried out to determine the prevalence of cryptococcal antigen (CrAg) and the relationship of positivity to CD4+ve T cell counts and WHO clinical stage among severely immunocompromised treatment naïve adult HIV-infected Nigerian patients. Methods: This was a hospital based cross sectional and prospective study carried out among newly diagnosed and confirmed HIV infected patients. Bio data of consenting consecutive subjects was collected by the attending physician using structured questionnaire. Rapid point of care lateral flow assay kits (IMMY, USA) was used to screen plasma samples from subjects strictly following manufacturer's instructions. Data were analysed with statistical package for social sciences (spss 15.0) software. Results were presented in simple tables with frequencies and percentages while statistical significance was taken to be p value ≤ 0.05. Results: Of 432 subjects, there were 184 (42.6%) males and 248 (57.4%) females in the study. The median CD4 count of the subjects was 74 (range 6 - 1264) cells/ul. Seven (1.6%) of the subjects were positive for cryptococcal antigen (CrAg) and all were females (100%). Six (85.7%) of CrAg positives had CD4+ T cell count less than 100 cells, while 1 (14.3%) had count above 200cells/ul. The WHO clinical stage of studied patients was; stage I 163 (37.7%), stage II 132 (30.6%) stage III 95 (22.0%) and stage IV 42 (9.7%). Among the CrAg positive subjects, 3 (42.9%) were in WHO clinical stage l while 4 (57.1%) were in stage II disease. Conclusion: The observed overall prevalence of CrAg positivity among studied patients was low but occurred most frequently among the severely immunocompromised subjects. Advancement in WHO clinical stage was not a predicting risk factor for cryptococcal antigenaemia in studied adult HIV infected patients.

Keywords

HIV, Cryptococcal Antigen, Infected Adults, Nigeria.
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  • Cryptococcal Antigenaemia among Treatment-Naive Adult HIV-Infected Nigerian Patients

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Authors

Taiwo Modupe Balogun
Antiretroviral Therapy Clinic, Haematology Department, Lagos State University Teaching Hospital, Lagos, Nigeria
Mbang Okokon
Antiretroviral Therapy Clinic, Haematology Department, Lagos State University Teaching Hospital, Lagos, Nigeria
Faleye Dasola
Antiretroviral Therapy Clinic, Haematology Department, Lagos State University Teaching Hospital, Lagos, Nigeria
Esuola Joseph Oyetubosun
Antiretroviral Therapy Clinic, Haematology Department, Lagos State University Teaching Hospital, Lagos, Nigeria
Adewolu Abimbola
Antiretroviral Therapy Clinic, Haematology Department, Lagos State University Teaching Hospital, Lagos, Nigeria
Basil Bonaventure
Antiretroviral Therapy Clinic, Haematology Department, Lagos State University Teaching Hospital, Lagos, Nigeria

Abstract


Background: There is a high burden of HIV-related cryptococcal meningitis in Sub-Saharan Africa and it is a leading cause of morbidity and early mortality among severely immunocompromised patients. Objectives of the Study: This study was carried out to determine the prevalence of cryptococcal antigen (CrAg) and the relationship of positivity to CD4+ve T cell counts and WHO clinical stage among severely immunocompromised treatment naïve adult HIV-infected Nigerian patients. Methods: This was a hospital based cross sectional and prospective study carried out among newly diagnosed and confirmed HIV infected patients. Bio data of consenting consecutive subjects was collected by the attending physician using structured questionnaire. Rapid point of care lateral flow assay kits (IMMY, USA) was used to screen plasma samples from subjects strictly following manufacturer's instructions. Data were analysed with statistical package for social sciences (spss 15.0) software. Results were presented in simple tables with frequencies and percentages while statistical significance was taken to be p value ≤ 0.05. Results: Of 432 subjects, there were 184 (42.6%) males and 248 (57.4%) females in the study. The median CD4 count of the subjects was 74 (range 6 - 1264) cells/ul. Seven (1.6%) of the subjects were positive for cryptococcal antigen (CrAg) and all were females (100%). Six (85.7%) of CrAg positives had CD4+ T cell count less than 100 cells, while 1 (14.3%) had count above 200cells/ul. The WHO clinical stage of studied patients was; stage I 163 (37.7%), stage II 132 (30.6%) stage III 95 (22.0%) and stage IV 42 (9.7%). Among the CrAg positive subjects, 3 (42.9%) were in WHO clinical stage l while 4 (57.1%) were in stage II disease. Conclusion: The observed overall prevalence of CrAg positivity among studied patients was low but occurred most frequently among the severely immunocompromised subjects. Advancement in WHO clinical stage was not a predicting risk factor for cryptococcal antigenaemia in studied adult HIV infected patients.

Keywords


HIV, Cryptococcal Antigen, Infected Adults, Nigeria.