Implementation and operational research: Integrated pre-antiretroviral therapy screening and treatment for tuberculosis and cryptococcal antigenemia

Journal of Acquired Immune Deficiency Syndromes : JAIDS
Lincoln PacYukari C Manabe

Abstract

To demonstrate the feasibility of integrated screening for cryptococcal antigenemia and tuberculosis (TB) before antiretroviral therapy (ART) initiation and to assess disease specific and all-cause mortality in the first 6 months of follow-up. We enrolled a cohort of HIV-infected, ART-naive adults with CD4 counts ≤250 cells per microliter in rural Uganda who were followed for 6 months after ART initiation. All subjects underwent screening for TB; those with CD4 ≤100 cells per microliter also had cryptococcal antigen (CrAg) screening. For those who screened positive, standard treatment for TB or preemptive treatment for cryptococcal infection was initiated, followed by ART 2 weeks later. Of 540 participants enrolled, pre-ART screening detected 10.6% (57/540) with prevalent TB and 6.8% (12/177 with CD4 count ≤100 cells/μL) with positive serum CrAg. After ART initiation, 13 (2.4%) patients were diagnosed with TB and 1 patient developed cryptococcal meningitis. Overall 7.2% of participants died (incidence rate 15.6 per 100 person-years at risk). Death rates were significantly higher among subjects with TB and cryptococcal antigenemia compared with subjects without these diagnoses. In multivariate analysis, significant risk factors ...Continue Reading

References

Oct 27, 2005·Journal of Acquired Immune Deficiency Syndromes : JAIDS·C William WesterRichard Marlink
Aug 15, 2006·JAMA : the Journal of the American Medical Association·Jeffrey S A StringerMoses Sinkala
Sep 16, 2006·American Journal of Respiratory and Critical Care Medicine·Robin WoodLinda-Gail Bekker
Aug 19, 2007·Tropical Medicine & International Health : TM & IH·Cheryl A LiechtyJonathan Mermin
Feb 19, 2009·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Joseph N JarvisThomas S Harrison
Aug 14, 2009·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Barbara CastelnuovoAndrew Kambugu
Aug 26, 2010·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Ingrid V BassettKenneth A Freedberg
Oct 12, 2010·Bulletin of the World Health Organization·Christopher DubeJames B Simpungwe
Jan 5, 2011·Clinical & Developmental Immunology·William WorodriaRobert Colebunders
Aug 23, 2011·Journal of Acquired Immune Deficiency Syndromes : JAIDS·David M MooreJonathan Mermin
Sep 24, 2011·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Joseph N JarvisThomas R Kozel
Jul 17, 2012·The International Journal of Tuberculosis and Lung Disease : the Official Journal of the International Union Against Tuberculosis and Lung Disease·Y HanifaA D Grant
Aug 7, 2012·The International Journal of Tuberculosis and Lung Disease : the Official Journal of the International Union Against Tuberculosis and Lung Disease·D NanseraF M Graziano
Nov 29, 2012·Current Opinion in HIV and AIDS·Reuben GranichJulio Montaner
Feb 9, 2013·The Journal of Antimicrobial Chemotherapy·Jacques D A NdawinzVirginie Supervie
Jan 15, 2014·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Dorita AvilaMatthias Egger
Jan 31, 2014·Journal of the International AIDS Society·Ahmad Rizal GaniemReinout van Crevel
Mar 29, 2014·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Lydia NakiyingiSusan E Dorman
Jun 26, 2014·The New England Journal of Medicine·David R BoulwareUNKNOWN COAT Trial Team

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Citations

Nov 14, 2015·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Nicky LongleyThomas S Harrison
Jul 15, 2015·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Yukari C Manabe, Richard D Moore
Dec 9, 2016·The American Journal of Tropical Medicine and Hygiene·Yukari C ManabeFrank Cobelens
Oct 14, 2017·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Rachel M WakeNelesh P Govender
Jun 4, 2016·Current Clinical Microbiology Reports·Mark W TenfordeJoseph N Jarvis
Mar 21, 2019·JMIR Public Health and Surveillance·Brian RiceJames Hargreaves
Jun 1, 2019·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Godfather Dickson KimaroLouis W Niessen
Mar 8, 2018·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Nathan FordGraeme Meintjes
Jun 11, 2019·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Rachel M WakeThomas S Harrison
Jun 23, 2020·Expert Review of Anti-infective Therapy·Greg GreeneJoseph N Jarvis

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