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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
immunology and microbiology
Asymptomatic serum cryptococcal antigenemia and early mortality during antiretroviral therapy in rural Uganda
Tropical Medicine and International Health, Volume 12, No. 8, Year 2007
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Description
Objective: To evaluate the association between a positive serum cryptococcal antigen (CRAG) test at baseline and mortality during the first 12 weeks on antiretroviral therapy (ART). Cryptococcal meningitis is a leading cause of HIV-related mortality in Africa, but current guidelines do not advocate CRAG testing as a screening tool. Methods: Between May 2003 and December 2004, we enrolled HIV-1 infected individuals into a study of ART monitoring in rural Uganda. CRAG testing was conducted retrospectively on stored pre-ART serum samples of participants whose baseline CD4 cell count was <100 cells/μl and who were without symptoms suggestive of disseminated cryptococcal disease at enrolment. Results: Of 377 participants, 5.8% had serum CRAG titre ≥1:2. Of these, 23% died during follow-up. Controlling for CD4 cell count, HIV-1 viral load, anaemia, active tuberculosis and body mass index, relative risk of death during follow-up among those with asymptomatic cryptococcal antigenemia at baseline was 6.6 [95% confidence interval (CI) 1.86-23.61, P = 0.0036]. The population attributable risk for mortality associated with a positive CRAG at baseline was 18% (CI 2-33%), similar to that associated with active tuberculosis (19%, CI 1-36%). Conclusion: Asymptomatic cryptococcal antigenemia independently predicts death during the first 12 weeks of ART among individuals with advanced HIV disease in rural Uganda. Routine screening and provision of azole antifungal therapy prior to or simultaneous with the start of ART should be evaluated for the potential to prevent mortality in this population. © 2007 Blackwell Publishing Ltd.
Authors & Co-Authors
Liechty, Cheryl A.
Uganda, Entebbe
Cdc-uganda
United States, San Francisco
University of California, San Francisco
Solberg, Peter
Uganda, Entebbe
Cdc-uganda
United States, San Francisco
University of California, San Francisco
Were, Willy A.
Uganda, Entebbe
Cdc-uganda
Ekwaru, John Paul
Uganda, Entebbe
Cdc-uganda
Ransom, Ray L.
Uganda, Entebbe
Cdc-uganda
Weidle, Paul J.
United States, Atlanta
National Center for Hiv, Viral Hepatitis, Std, and tb Prevention
United States, Atlanta
Centers for Disease Control and Prevention
Downing, Robert G.
Uganda, Entebbe
Cdc-uganda
Coutinho, Alex G.
Uganda, Kampala
Aids Support Organization Uganda
Mermin, Jonathan H.
Uganda, Entebbe
Cdc-uganda
Statistics
Citations: 207
Authors: 9
Affiliations: 5
Identifiers
Doi:
10.1111/j.1365-3156.2007.01874.x
ISSN:
13602276
e-ISSN:
13653156
Research Areas
Infectious Diseases
Study Design
Cross Sectional Study
Cohort Study
Study Locations
Uganda