PMID: 28527158May 21, 2017Paper

Asymptomatic Cryptococcal Antigenemia in People Living with HIV (PLHIV) with Severe Immunosuppression: Is Routine CrAg Screening Indicated in India?

The Journal of the Association of Physicians of India
S AnuradhaK Rajeshwari

Abstract

Cryptococcal meningitis (CM) is a common, life-threatening opportunistic infection (OI) among people living with HIV (PLHIV) in India. Serum Cryptococcal antigen (CrAg) positivity is predictive of future occurrence of CM and pre-emptive treatment reduces its mortality. Routine CrAg screening among PLHIV is not adopted by India's national programme. This study evaluated the prevalence of CrAg and assessed CrAg positivity in predicting all-cause mortality among PLHIV. This prospective study was conducted in a tertiary care, public health facility in New Delhi, India. Prevalence of CrAg was assessed in 128 ART naive adult PLHIV with CD4 < 100 cells/mm3 using a latex agglutination test. Age, gender, weight, body mass index (BMI), CD4 count, haemoglobin, serum albumin, and presence of other OI were evaluated as determinants of CrAg positivity. Subjects were followed up for occurrence of CM and mortality (all-cause) at 12 weeks and 6 months. The mean age of the subjects was 36.2±9.48 years, 73.4% were men, 21.09% women and 5.46% were transgender. The mean BMI was 18.4±2.53 kg/m2 and 64% of subjects belonged to the lower socio-economic strata. Mean CD4 counts of the subjects was 54.9±26.58 cells/mm3 and 42.97% had CD4 < 50 cells/mm3. ...Continue Reading

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