Asymptomatic cryptococcal antigen prevalence detected by lateral flow assay in hospitalised HIV-infected patients in São Paulo, Brazil

José E. Vidal, Carolina Toniolo, Adriana Paulino, Arnaldo Colombo, Marilena dos Anjos Martins, Cristina da Silva Meira, Vera Lucia Pereira-Chioccola, Claudia Figueiredo-Mello, Tiago Barros, Jequelie Duarte, Fernanda Fonseca, Mirella Alves Cunha, Clara Mendes, Taiana Ribero, Marcia dos Santos Lazera, Radha Rajasingham, David R. Boulware

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Abstract

Objective: To determine the prevalence of asymptomatic cryptococcal antigen (CRAG) using lateral flow assay (LFA) in hospitalised HIV-infected patients with CD4 counts <200 cells/μl. Methods: Hospitalised HIV-infected patients were prospectively recruited at Instituto de Infectologia Emilio Ribas, a tertiary referral hospital to HIV-infected patients serving the São Paulo State, Brazil. All patients were >18 years old without prior cryptococcal meningitis, without clinical suspicion of cryptococcal meningitis, regardless of antiretroviral (ART) status, and with CD4 counts <200 cells/μl. Serum CRAG was tested by LFA in all patients, and whole blood CRAG was tested by LFA in positive cases. Results: We enrolled 163 participants of whom 61% were men. The duration of HIV diagnosis was a median of 8 (range, 1–29) years. 26% were antiretroviral (ART)-naïve, and 74% were ART-experienced. The median CD4 cell count was 25 (range, 1–192) cells/μl. Five patients (3.1%; 95%CI, 1.0–7.0%) were asymptomatic CRAG-positive. Positive results cases were cross-verified by performing LFA in whole blood. Conclusions: 3.1% of HIV-infected inpatients with CD4 <200 cells/μl without symptomatic meningitis had cryptococcal antigenemia in São Paulo, suggesting that routine CRAG screening may be beneficial in similar settings in South America. Our study reveals another targeted population for CRAG screening: hospitalised HIV-infected patients with CD4 <200 cells/μl, regardless of ART status. Whole blood CRAG LFA screening seems to be a simple strategy to prevention of symptomatic meningitis.

Original languageEnglish (US)
Pages (from-to)1539-1544
Number of pages6
JournalTropical Medicine and International Health
Volume21
Issue number12
DOIs
StatePublished - Dec 1 2016

Keywords

  • Cryptococcus
  • HIV/AIDS
  • cryptococcal meningitis
  • cryptococcal polysaccharide
  • cryptococcal screening
  • prevalence

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    Vidal, J. E., Toniolo, C., Paulino, A., Colombo, A., dos Anjos Martins, M., da Silva Meira, C., Pereira-Chioccola, V. L., Figueiredo-Mello, C., Barros, T., Duarte, J., Fonseca, F., Alves Cunha, M., Mendes, C., Ribero, T., dos Santos Lazera, M., Rajasingham, R., & Boulware, D. R. (2016). Asymptomatic cryptococcal antigen prevalence detected by lateral flow assay in hospitalised HIV-infected patients in São Paulo, Brazil. Tropical Medicine and International Health, 21(12), 1539-1544. https://doi.org/10.1111/tmi.12790