Should we perform the serum cryptococcal antigen test in people living with HIV hospitalized due to a community-acquired pneumonia episode?

Adriana Paulino Silva, Carolina Toniolo Zenatti, Claudia Figueiredo-Mello, Marinella Della Negra, Anna S. Levin, David R. Boulware, José Ernesto Vidal

Research output: Contribution to journalArticlepeer-review

Abstract

Community-acquired pneumonia (CAP) is a common cause of hospitalization among people living with human immunodeficiency virus (PLWH), particularly those with severe immunosuppression. Pulmonary disease due to cryptococcosis is uncommonly reported and likely under-diagnosed. There is scarce information about cryptococcal antigen (CrAg) prevalence in PLWH with CAP. The objectives of this study were to identify among PLWH who were hospitalized with CAP: (i) the prevalence of serum CrAg positivity, (ii) the proportion with asymptomatic vs. symptomatic cryptococcosis; and (iii) the prevalence of serum CrAg positivity in CD4+ T-cell count <100 cells/mm3. We performed a sub-analysis of a prospective cohort of hospitalized adults enrolled into a randomized clinical trial testing therapy for CAP. We included 202 participants who had serum CrAg testing performed. We found a 3.5% prevalence of serum CrAg-positivity overall, being higher (5.7%) in CD4+ T-cell count <100 cells/mm3. Overall, asymptomatic and symptomatic cryptococcosis were present in 2.0% and 1.5%, respectively. This study identifies a target population for CrAg testing: PLWH hospitalized with diagnosis of CAP, particularly those with CD4+ T-cell count <100 cells/mm3 where the number needed to test was 18 to detect 1 CrAg-positive person. This approach may facilitate the detection of asymptomatic cryptococcal infection and allow a timely diagnosis of symptomatic cryptococcal disease.

Original languageEnglish (US)
Pages (from-to)345-350
Number of pages6
JournalInternational Journal of STD and AIDS
Volume31
Issue number4
DOIs
StatePublished - Mar 1 2020

Keywords

  • Cryptococcosis
  • community-acquired pneumonia
  • cryptococcal antigen
  • diagnosis
  • pneumonia

PubMed: MeSH publication types

  • Journal Article

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