Methods: This was a prospective cohort study conducted between 1st March 2010 and 1st March 2017 at three private hospitals in Pune, India. All HIV-positive patients (symptomatic and asymptomatic) with CD4 counts ≤ 200 cells/µL were screened for serum cryptococcal antigen. Serum CrAg was measured using latex agglutination (LA) test. Both, ART naïve and ART experienced patients were included in the study. All HIV infected patients who were CrAg-positive were offered lumbar puncture (LP) and worked up for disseminated cryptococcal disease.
Results: 785 HIV positive patients (24.2% females) were included. Median age of cohort was 42 years (IQR, 35-49) and median CD4 count was 79 cells/mm3 (IQR, 37-82). 182/785(23.2%) patients were ART experienced. A total of 6.75% (53/785) of patients were CrAg positive in serum. 39/53(73.6%) patients with positive serum cryptococcal antigen test had CD4 count ≤100 cells/mm3 while 14/53(26.4%) had CD4 between 100-200 cells/mm3. Cerebrospinal fluid (CSF) CrAg was positive in 44/53(83%) patients. 2/53(3.78%) had non-CNS, diffuse pulmonary cryptococcal disease and 7/53(13.2%) patients had isolated cryptococcal antigenemia. Patients with cryptococcal meningitis and crptococcal pulmonary disease were treated with Amphotericin-B plus oral Fluconazole. Patients with isolated cryptococcal antigenemia were treated with oral Fluconazole. Mortality at 6 months for patients with positive CrAg test was 22.6%(12/53).
Conclusion: We found 6.75% prevalence of cryptococcaemia amongst HIV patients with CD4 <200 cells/mm3. Given the high fatality rates observed, routine CrAg screening should be considered for all Indians with advanced HIV disease.
M. K. Medisetty,
A. Dravid, None