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High prevalence of cryptococcal antigenaemia amongst asymptomatic advanced HIV patients in Pune, India
Indian Journal of Medical Microbiology
Methods: A prospective study was conducted in a large public sector ART centre and the inpatient wards of Sassoon Hospital, Pune, India. All consenting patients> 18 years of age with CD4 count <100 cells/mm3 were screened for CrAg by latex agglutination assay. Those with positive CrAg underwent cerebrospinal fluid analysis, chest radiograph and abdominal ultrasound to rule out cryptococcal disease. The impact of CrAg positivity on all-cause mortality was assessed by logistic regression analysis.
Results: Amongst 208 AIDS patients with CD4 cells <100 cells/mm3 who underwent CrAg testing, median age was 40 (interquartile range [IQR], 35-49) years, 134 (64%) were male and median CD4 count was 64.5 cells/mm3 (IQR, 37-82). Overall, 16 (8%, 95% confidence interval [CI], 4-12) patients were positive for CrAg, of which 8 (50%) had CD4 cells <50 cells/mm3 and 3 (19%) CrAg-positive patients had incidental cryptococcal meningitis. At 6-month follow-up, the case fatality rate was higher amongst CrAg-positive patients (38%) compared with CrAg-negative patients (18%) (P = 0.06). After adjusting for age, sex, CD4 count and ART, there was a trend towards increased all-cause mortality (adjusted OR, 3.18, 95% CI, 0.60-16.88,P= 0.17).
Kadam D, Chandanwale A, Bharadwaj R, Nevrekar N, Joshi S, Patil S, Gupte N, Sangle S, Chopade K, Kulkarni V, Balasubramanian U, Suryavanshi N, Jain D, Kanade S, Dharmashale S, Kagal A, Gupta A, Mave V. High prevalence of cryptococcal antigenaemia amongst asymptomatic advanced HIV patients in Pune, India. Indian J Med Microbiol. 2017 Jan-Mar;35(1):105-108. doi: 10.4103/ijmm.IJMM_15_596. PMID: 28303828.