Cryptococcal Antigenemia in Human Immunodeficiency Virus Antiretroviral Therapy–Experienced Ugandans With Virologic Failure

Simple item page
dc.contributor.authorMpoza, Edward
dc.contributor.authorRadha, Rajasingham
dc.contributor.authorTugume, Lillian
dc.contributor.authorJoshua, Rhein
dc.contributor.authorNabaggala, Maria Sarah
dc.contributor.authorSsewanyana, Isaac
dc.contributor.authorNyegenye, Wilson
dc.contributor.authorKushemererwa, Grace Esther
dc.contributor.authorMulema, Vivienne
dc.contributor.authorKalamya, Julius
dc.contributor.authorKiyaga, Charles
dc.contributor.authorKabanda, Joseph
dc.contributor.authorSsali, Mina
dc.contributor.authorBoulware, David R.
dc.contributor.authorMeya, David B.
dc.date.accessioned2025-04-10T16:39:51Z
dc.date.available2025-04-10T16:39:51Z
dc.date.issued2020
dc.description.abstractDetectable serum or plasma cryptococcal antigen (CrAg) precedes symptomatic cryptococcal meningitis. The World Health Organization recommends CrAg screening for human immunodeficiency virus–positive persons with CD4 count <100 cells/μL initiating antiretroviral therapy (ART). However, an increasing proportion of patients with cryptococcosis are now ART experienced. Whether CrAg screening is cost-effective in those with virologic failure is unknown. Methods We retrospectively performed nationwide plasma CrAg testing among ART-experienced Ugandan adults with virologic failure (≥1000 copies/mL) using leftover plasma after viral load testing during September 2017–January 2018. For those who were CrAg positive, we obtained ART history, meningitis occurrence, and 6-month survival via medical records review. Results Among 1186 subjects with virologic failure, 35 (3.0%) were CrAg positive with median ART duration of 41 months (interquartile range, 10–84 months). Among 25 subjects with 6-month outcomes, 16 (64%) survived, 7 (28%) died, and 2 (8%) were lost. One survivor had suffered cryptococcal meningitis 2 years prior. Two others developed cryptococcal meningitis and survived. Five survivors were known to have received fluconazole. Thus, meningitis-free survival at 6 months was 61% (14/23). Overall, 91% (32/35) of CrAg-positive persons had viral load ≥5000 copies/mL compared with 64% (735/1151) of CrAg-negative persons (odds ratio, 6.0 [95% confidence interval, 1.8–19.8]; P = .001). CrAg prevalence was 4.2% (32/768) among those with viral loads ≥5000 copies/mL and 0.7% (3/419) among those with viral loads <5000 copies/mL. Conclusions In addition to the CD4 threshold of <100 cells/μL, reflexive CrAg screening should be considered in persons failing ART in Uganda with viral loads ≥5000 copies/mL.
dc.identifier.citationMpoza, E., Rajasingham, R., Tugume, L., Rhein, J., Nabaggala, M. S., Ssewanyana, I., ... & Meya, D. B. (2020). Cryptococcal antigenemia in human immunodeficiency virus antiretroviral therapy–experienced Ugandans with virologic failure. Clinical infectious diseases, 71(7), 1726-1731. DOI: 10.1093/cid/ciz1069
dc.identifier.other10.1093/cid/ciz1069
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/10474
dc.language.isoen
dc.publisherClinical infectious diseases
dc.titleCryptococcal Antigenemia in Human Immunodeficiency Virus Antiretroviral Therapy–Experienced Ugandans With Virologic Failure
dc.typeArticle
Files
Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
Cryptococcal Antigenemia in Human Immunodeficiency.pdf
Size:
205.35 KB
Format:
Adobe Portable Document Format
Download
License bundle
Now showing 1 - 1 of 1
No Thumbnail Available
Name:
license.txt
Size:
1.71 KB
Format:
Item-specific license agreed upon to submission
Description:
Download
Collections
Medical and Health Sciences