Occult cryptococcal antigen in HIV patients with possible TB in Uganda
More than 1 in 20 HIV-positive patients with suspected tuberculosis in a Kampala hospital had cryptococcal antigenemia. But a positive cryptococcal test did not raise the death risk through 2 months of follow-up.
Cryptococcal infection often afflicts people with advanced
HIV infection and may prove fatal. To learn more about the
prevalence and outcomes of cryptococcal antigenemia in
hospitalized HIV-positive patients in Uganda, the
International HIV-Associated Opportunistic Pneumonias (IHOP)
Study conducted this analysis.
From September 2009 through September 2010, IHOP investigators
enrolled consecutive HIV-positive adults admitted to Mulago
Hospital in Kampala with unexplained cough for at least 2
weeks and suspected tuberculosis. The researchers tested
stored serum samples for cryptococcal antigenemia. They
compared outcomes, including mortality, in patients with and
without cryptococcal antigenemia.
Among the 563 HIV-positive people tested, 32 (5.7%) tested
positive for cryptococcal antigenemia. Fungal culture of
bronchoalveolar lavage fluid detected
Cryptococcus neoformans in none of 116 people
tested.
Compared with cryptococcal antigen-negative people, those with
a positive test had a significantly lower median CD4 count (25
versus 55 cells/μL, P = 0.02). Almost one third of
cryptococcal antigen-positive people (31%) had concurrent
tuberculosis.
Two months after cryptococcal antigen testing,
antigen-positive people did not have higher mortality than
antigen-negative people (hazard ratio 0.99, 95% confidence
interval 0.63 to 1.54, P = 0.95) after statistical
adjustment for CD4 count and antiretroviral therapy at
enrollment and/or during follow-up.
The IHOP investigators propose that cryptococcal antigen
testing “should be considered in hospitalized
HIV-seropositive patients with CD4 count [below] 50
cells/μL, coupled with longer follow-up to evaluate the
diagnostic value of cryptococcal antigen and therapeutic
interventions in patients with asymptomatic cryptococcal
antigenemia.”
Source: Alfred
O. Andama, Saskia den Boon, David Meya, Adithya Cattamanchi,
William Worodria, J. Lucian Davis, Nicholas D. Walter, Samuel
D. Yoo, Nelson Kalema, Barbara Haller, Laurence Huang, on
behalf of the International HIV-Associated Opportunistic
Pneumonias (IHOP) Study. Prevalence and outcomes of
cryptococcal antigenemia in HIV-seropositive patients
hospitalized for suspected tuberculosis in Uganda.
JAIDS. 2013; 63: 189-194.
For the study abstract
(Downloading the complete article requires a
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abstract is
free.)
Source:
IAS
