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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
immunology and microbiology
Cryptococcal infection in a cohort of HIV-1-infected Ugandan adults
AIDS, Volume 16, No. 7, Year 2002
Notification
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Description
Objective: Despite the recognition of Cryptococcus neoformans as a major cause of meningitis in HIV-infected adults in sub-Saharan Africa, little is known about the relative importance of this potentially preventable infection as a cause of mortality and suffering in HIV-infected adults in this region. Design: A cohort study of 1372 HIV-1-infected adults, enrolled and followed up between October 1995 and January 1999 at two community clinics in Entebbe, Uganda. Methods: Systematic and standardized assessment of illness episodes to describe cryptococcal disease and death rates. Results: Cryptococcal disease was diagnosed in 77 individuals (rate 40.4/1000 person-years) and was associated with 17% of all deaths (77 out of 444) in the cohort. Risk of infection was strongly associated with CD4 T cell counts < 200 × 106 cells/1(75 patients) and World Health Organization (WHO) clinical stage 3 and 4 (68 patients). Meningism was present infrequently on presentation (18%). Clinical findings had limited discriminatory diagnostic value. Serum cryptococcal antigen testing was the most sensitive and robust diagnostic test. Cryptococcal antigenaemia preceded symptoms by a median of 22 days (> 100 days in 11% of patients). Survival following diagnosis was poor (median survival 26 days; range 0-138). Conclusions: Cryptococcal infection is an important contributor to mortality and suffering in HIV-infected Ugandans. Improvements in access to effective therapy of established disease are necessary. In addition, prevention strategies, in particular chemoprophylaxis, should be evaluated while awaiting the outcome of initiatives to make antiretroviral therapy more widely available. © 2002 Lippincott Williams & Wilkins.
Authors & Co-Authors
French, N.
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Gray, Katherine J.
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Watera, Christine
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Nakiyingi, Jessica S.
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Lugada, Eric S.
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Moore, Mike J.
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Lalloo, David G.
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Whitworth, James Ag
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Gilks, Charles F.
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Statistics
Citations: 348
Authors: 9
Affiliations: 1
Identifiers
Doi:
10.1097/00002030-200205030-00009
ISSN:
02699370
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cohort Study
Study Approach
Quantitative
Study Locations
Uganda