553. Survival in HIV-infected Asymptomatic Cryptococcal Antigenemia without CSF Positivity Treated with Fluconazole Did Not Differ from Cryptococcal Antigen (CrAg) Negative with CD4 <150.
Session: Poster Abstract Session: HIV and Fungal Infection
Thursday, October 5, 2017
Room: Poster Hall CD
Background: Cryptococcal meningitis causes 15% of HIV/AIDS-related deaths; however, meningitis can be prevented by early screening and giving preemptive treatment to a high-risk population.

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.

Tafese Beyene Tufa, MSc, College of Health Sciences, Arsi University, Asella, Ethiopia, Anteneh Girma, MD, Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA., Minneapolis, MN, Radha Rajasingham, MD, Infectious Diseases & International Medicine University of Minnesota, Minneapolis, MN; Medicine, University of Minnesota, Minneapolis, MN; Infectious Disease Institute, Kampala, Uganda and David Boulware, MD, MPH, Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN


T. B. Tufa, None

A. Girma, None

R. Rajasingham, None

D. Boulware, None

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