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Prevalence of Asymptomatic Cryptococcal Antigenemia and Association with Follow-up Risk of Cryptococcal Meningitis and Mortality among HIV Infected Patients in North West India: A Prospective Cohort Study

Author(s):

Rajendra Bhati, Pramendra Sirohi, Bharat Sejoo, Deepak Kumar*, Gopal K Bohra, Durga S Meena, Diwakar Verma and Naresh K Midha   Pages 1 - 5 ( 5 )

Abstract:


Objective: Cryptococcal meningitis is an important cause of morbidity and mortality in HIV infected individuals. In the era of universal antiretroviral therapy incidence of immune reconstitution inflammatory syndrome (IRIS) related cryptococcal meningitis has increased. Detection of serum cryptococcal antigen in asymptomatic PLHIV (People Living With HIV) and pre-emptive treatment with fluconazole can decrease the burden of cryptococcal disease. We conducted this study to find the prevalence of asymptomatic cryptococcal antigenemia in India and its correlation with mortality in PLHIV.

Method and material: This was a prospective observational study. HIV infected ART naïve patients with age of ≥ 18 years who had CD4 counts ≤ 100 /µL were included and serum cryptococcal antigen test was done. These patients were followed for six months to look for the development of Cryptococcal meningitis and mortality.

Results: A total of 116 patients were analysed. Asymptomatic cryptococcal antigenemia was detected in 5.17% patients and it correlated with increased risk of cryptococcal meningitis and mortality on follow-up in PLHIV.

Conclusion: Serum cryptococcal positivity is correlated with increased risk of Cryptococcal meningitis and mortality in PLHIV. We recommend the screening of asymptomatic PLHIV with CD4 ≤ 100/µL for serum cryptococcal antigen, so that pre-emptive treatment can be initiated to reduce morbidity and mortality.

Keywords:

Cryptococcal Meningitis, Serum Cryptococcal Antigen, Asymptomatic Cryptococcal Antigenemia, CD4 Counts, HIV Infection, antiretroviral therapy.

Affiliation:

Department of Medicine, All India Institute of Medical Sciences Jodhpur, Department of Medicine, S P Medical College Bikaner , Department of Medicine, All India Institute of Medical Sciences Jodhpur, Department of Medicine, All India Institute of Medical Sciences Jodhpur , Department of Medicine, All India Institute of Medical Sciences Jodhpur, Department of Medicine, All India Institute of Medical Sciences Jodhpur , Department of Emergency Medicine, All India Institute of Medical Sciences Jodhpur, Department of Medicine, All India Institute of Medical Sciences Jodhpur



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