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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Screening for cryptococcal antigenemia in patients accessing an antiretroviral treatment program in South Africa
Clinical Infectious Diseases, Volume 48, No. 7, Year 2009
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Description
Background. Cryptococcal meningitis is a leading cause of death in patients with acquired immunodeficiency syndrome and contributes substantially to the high early mortality in antiretroviral treatment (ART) programs in low-resource settings. Screening for cryptococcal antigen in patients who enroll in ART programs may identify those at risk of cryptococcal meningitis and permit targeted use of preemptive therapy. Methods. In this retrospective study, cryptococcal antigen was measured in stored plasma samples obtained from patients when they enrolled in a well-characterized ART cohort in South Africa. The predictive value of screening for cryptococcal antigen before initiation of ART for development of microbiologically confirmed cryptococcal meningitis or death during the first year of follow-up was determined. Results. Of 707 participants with a baseline median CD4 cell count of 97 cells/μL (interquartile range, 46-157 cells/μL), 46 (7%) were positive for cryptococcal antigen. Antigenemia was 100% sensitive for predicting development of cryptococcal meningitis during the first year of ART, and in multivariate analysis, it was an independent predictor of mortality (adjusted hazard ratio, 3.2; 95% confidence interval, 1.5-6.6). Most cases (92%) of cryptococcal meningitis developed in patients with a CD4 cell count ≤100 cells/μL. In this subset of patients, a cryptococcal antigen titer ≥ 1:8 was 100% sensitive and 96% specific for predicting incident cryptococcal meningitis during the first year of ART in those with no history of the disease. Conclusions. Cryptococcal antigen screening before initiation of ART in patients with a CD4 cell count ≤100 cells/μL is highly effective for identifying those at risk of cryptococcal meningitis and death and might permit implementation of a targeted preemptive treatment strategy. © 2009 by the Infectious Diseases Society of America. All rights reserved.
Authors & Co-Authors
Jarvis, Joseph N.
Unknown Affiliation
Lawn, Stephen D.
Unknown Affiliation
Vogt, Monica
Unknown Affiliation
Bangani, Nonzwakazi
Unknown Affiliation
Wood, Robin Y.
Unknown Affiliation
Harrison, Thomas Stephen
Unknown Affiliation
Statistics
Citations: 308
Authors: 6
Affiliations: 7
Identifiers
Doi:
10.1086/597262
ISSN:
10584838
Research Areas
Environmental
Study Design
Cohort Study
Study Locations
South Africa