Methods: We screened HIV-infected patients whose CD4+ count ≤150/µL for cryptococcal antigen (CrAg) from the left over plasma after CD4 count testing at Adama and Asella hospitals in Ethiopia. We conducted a prospective case-control study comparing the 6-month survival outcomes of 51 plasma CrAg+ patients with 100 randomly selected CrAg-negative patients from CrAg screening registration book within the same CD4 count ranges. CrAg+ patients were treated with appropriate antifungal drugs and both groups initiated HIV therapy according to national treatment guideline. All CrAg+ patients were offered lumbar puncture (LP) to exclude cerebrospinal fluid (CSF) CrAg-positivity. CrAg+ patients without central nerve system (CNS) disease were treated with fluconazole 800 mg/day until starting HIV therapy and 400mg/day thereafter for 8 weeks. CSF CrAg+ patients were treated with fluconazole 1200mg/day.
Results: CrAg was detected in 6.2% (n=51)of remaining plasma among 817 HIV-infected persons with CD4≤150/µL screened from August 2014 to March 2016. The mean CD4 count was 47cells/µL among CrAg+ and 73cells/µL in randomly selected CrAg-negative participants respectively. After 6-months, 49% (25/51) of CrAg+ and 19% of (19/100) CrAg-negative patients were dead or lost to follow-up (P<0.001). Among asymptomatic cryptococcal antigenemia (plasma CrAg+ but CSF CrAg-negative), the 24% (4/17) mortality rate did not differ from 19% mortality in plasma CrAg-negative (Odds Ratio 1.31, 95%CI: 0.38-4.5; P=0.66).
Conclusion: Mortality rate is higher among plasma CrAg+ than CrAg-negative HIV-infected with CD4 counts <150 cells/µL. However, survival did not differ between asymptomatic cryptococcal antigenemia (CSF CrAg negative) persons treated with oral fluconazole and CrAg-negative HIV-infected persons.
T. B. Tufa,
R. Rajasingham, None
D. Boulware, None