Cryptococcal antigen prevalence in HIV-infected Tanzanians: a cross-sectional study and evaluation of a point-of-care lateral flow assay.
Objectives: Cryptococcal antigen (CRAG) screening at antiretroviral therapy (ART) initiation and pre-emptive antifungal treatment for those testing positive could prevent many cases of cryptococcal meningitis (CM). To investigate whether CRAG screening would be feasible in Tanzania, we conducted a c...
| Published in: | Tropical Medicine & International Health Vol. 18; no. 9; pp. 1075 - 1080 |
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| Main Authors: | , , , , |
| Format: | research Journal Article |
| Published: |
Wiley-Blackwell
Sep2013
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104210641&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 104210641 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 13602276 1YC jtl: Tropical Medicine & International Health issn: 13602276 maglogo: Y pubinfo: dt: Sep2013 vid: 18 iid: 9 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 104210641 NLM23937699 2012225896 10.1111/tmi.12157 NLM23937699 104210641 ppf: 1075 ppct: 5 formats: tig: atl: Cryptococcal antigen prevalence in HIV-infected Tanzanians: a cross-sectional study and evaluation of a point-of-care lateral flow assay. aug: au: Rugemalila, Joan Maro, Venance P Kapanda, Gibson Ndaro, Arnold J Jarvis, Joseph N affil: Department of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania. sug: subj: AIDS-Related Opportunistic Infections Epidemiology Antifungal Agents Therapeutic Use Antigens, Fungal Blood Cryptococcus Immunology Meningitis, Cryptococcal Epidemiology AIDS-Related Opportunistic Infections Blood AIDS-Related Opportunistic Infections Diagnosis AIDS-Related Opportunistic Infections Drug Therapy Adult Anti-HIV Agents Therapeutic Use CD4 Lymphocyte Count Cross Sectional Studies Cryptococcus Female Human Male Meningitis, Cryptococcal Blood Meningitis, Cryptococcal Diagnosis Meningitis, Cryptococcal Drug Therapy Middle Age Clinical Information Systems Epidemiological Research Tanzania Adult: 19-44 years Middle Aged: 45-64 years Female Male ab: Objectives: Cryptococcal antigen (CRAG) screening at antiretroviral therapy (ART) initiation and pre-emptive antifungal treatment for those testing positive could prevent many cases of cryptococcal meningitis (CM). To investigate whether CRAG screening would be feasible in Tanzania, we conducted a cross-sectional study measuring CRAG prevalence in ART clinic patients and comparing the novel lateral flow assay (LFA) with the cryptococcal latex agglutination (LA) test.Methods: Consecutive HIV-infected outpatients with CD4 counts <200 cells/µL, who were ART naive or had been on ART for <6 months, were screened for CRAG using the LA and LFA kits. For further assay validation, HIV-infected inpatients with suspected cryptococcal disease were also tested using the LA and LFA kits.Results: Cryptococcal antigen was detected in seven of 218 ART clinic attendees (3%). Six patients (5%) with CD4 cell counts ≤100 cells/µL (n = 124) were CRAG-positive. Agreement between the LA and LFA test in the 218 outpatients was 100%. Another 101 inpatients were tested for CRAG, of whom 56 (55%) were CRAG-positive on both the LA and LFA tests. One patient was positive using the LFA test but negative on the LA test. The overall agreement between the two assays was 99.7%, kappa coefficient 0.99 (standard error 0.06, P < 0.001).Conclusions: Five percentage of ART clinic patients with CD4 cell counts ≤100 cells/µL in northern Tanzania had asymptomatic cryptococcal antigenaemia, suggesting that CRAG screening would be worthwhile in the Tanzanian ART programme. The LFA is a reliable, cheap and practical alternative to LA for detection of CRAG. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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