Cryptococcal Antigenaemia among Treatment-Naïve Adult HIV-Infected Nigerian Patients

Background: There is a high burden ofHIV-related cryptococcal meningitis in Sub-Saharan Africa and it is a leadingcause of morbidity and early mortality among severely immunocompromisedpatients. Objectives of the Study: This study was carried out to determine theprevalence of cryptococcal antigen (CrAg) and the relationship of positivity toCD4+ve T cell counts and WHO clinical stage among severely immunocompromisedtreatment naive adult HIV-infected Nigerian patients. Methods: This was ahospital based cross sectional and prospective study carried out among newlydiagnosed and confirmed HIV infected patients. Bio data of consentingconsecutive subjects was collected by the attending physician using structuredquestionnaire. Rapid point of care lateral flow assay kits (IMMY, USA) was usedto screen plasma samples from subjects strictly following manufacturer’sinstructions. Data were analysed with statistical package for social sciences(spss 15.0) software. Results were presented in simple tables with frequenciesand percentages while statistical significance was taken to be p value ≤ 0.05.Results: Of 432 subjects, there were 184 (42.6%) males and 248 (57.4%) femalesin the study. The median CD4 count of the subjects was 74 (range 6 - 1264)cells/ul. Seven (1.6%) of the subjects were positive for cryptococcal antigen(CrAg) and all were females (100%). Six (85.7%) of CrAg positives had CD4+ Tcell count less than 100 cells, while 1 (14.3%) had count above 200cells/ul.The WHO clinical stage of studied patients was; stage I 163 (37.7%), stage II132 (30.6%) stage III 95 (22.0%) and stage IV 42 (9.7%). Among the CrAgpositive subjects, 3 (42.9%) were in WHO clinical stage l while 4 (57.1%) werein stage II disease. Conclusion: The observed overall prevalence of CrAgpositivity among studied patients was low but occurred most frequently amongthe severely immunocompromised subjects. Advancement in WHO clinical stage wasnot a predicting risk factor for cryptococcal antigenaemia in studied adult HIVinfected patients.