Cryptococcal Antigen Screening Among Antiretroviral Therapy–Experienced People With HIV With Viral Load Nonsuppression in Rural Uganda
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
Oxford University Press
Abstract
The World Health Organization recommends screening for the cryptococcal antigen (CrAg), a predictor of cryptococcal
meningitis, among antiretroviral therapy (ART)–naïve people with HIV (PWH) with CD4 <100 cells/mm3. CrAg positivity among
ART-experienced PWH with viral load (VL) nonsuppression is not well established, yet high VLs are associated with cryptococcal meningitis
independent of CD4 count. We compared the frequency and positivity yield of CrAg screening among ART-experienced PWH with
VL nonsuppression and ART-naïve PWH with CD4 <100 cells/mm3 attending rural public health facilities in Uganda.
Methods. We reviewed routinely generated programmatic reports on cryptococcal disease screening from 104 health facilities in 8
rural districts of Uganda from January 2018 to July 2019. A lateral flow assay (IMMY CrAg) was used to screen for cryptococcal disease.
PWH were eligible for CrAg screening if they were ART-naïve with CD4 <100 cell/mm3 or ART-experienced with an HIV VL >1000
copies/mL after at least 6 months of ART. We used Pearson’s chi-square test to compare the frequency and yield of CrAg screening.
Results. Of 71 860 ART-experienced PWH, 7210 (10.0%) were eligible for CrAg screening. Among 15 417 ART-naïve PWH, 5719
(37.1%) had a CD4 count measurement, of whom 937 (16.4%) were eligible for CrAg screening. The frequency of CrAg screening was
11.5% (830/7210) among eligible ART-experienced PWH compared with 95.1% (891/937) of eligible ART- naïve PWH (P < .001). The
CrAg positivity yield was 10.5% among eligible ART-experienced PWH compared with 13.8% among eligible ART-naïve PWH (P = .035).
Conclusions. The low frequency and high positivity yield of CrAg screening among ART-experienced PWH with VL
nonsuppression suggest a need for VL- directed CrAg screening in this population. Studies are needed to evaluate the cost-effectiveness
and impact of CrAg screening and fluconazole prophylaxis on the outcomes of ART-experienced PWH with VL nonsuppression.
Description
Keywords
ART-experienced, Viral load, Nonsuppression, HIV, CrAg, Cryptococcal meningitis
Citation
Baluku, J. B., Mugabe, P., Mwebaza, S., Nakaweesi, J., Senyimba, C., Opio, J. P., & Mukasa, B. (2021, February). Cryptococcal Antigen Screening Among Antiretroviral Therapy–Experienced People With HIV With Viral Load Nonsuppression in Rural Uganda. In Open Forum Infectious Diseases (Vol. 8, No. 2, p. ofab010). US: Oxford University Press. DOI: 10.1093/ofid/ofab010