Abstract
BackgroundCryptococcosis is an opportunistic fungal infection that primarily affects people with advanced HIV/AIDS and is an important cause of morbidity and mortality around the globe. By far the most common presentation of the disease is cryptococcal meningitis (CM), which leads to an estimated 15–20% of all HIV related deaths worldwide, 75% of which are in sub-Saharan Africa. However, to the best of our knowledge there is quite limited reviewed data on the epidemiology of cryptococcal antigenemia in a large HIV-infected population in resource limited settings.MethodsArticles published in English irrespective of the time of publication were systematically searched using comprehensive search strings from PubMed/Medline and SCOPUS. In addition, Google Scholar and Google databases were searched manually for grey literature. Two reviewers independently assessed study eligibility, extracted data, and assessed risk of bias. The pooled prevalence of cryptococcal antigenemia was determined with 95% confidence interval (CI).ResultsAmong 2941 potential citations, we have included 22 studies with a total of 8338 HIV positive individuals. The studies were reported in ten different countries during the year (2007–2018). Most of the articles reported the mean CD4 count of the participants below 100 cells/μl. The pooled prevalence of cryptococcal antigenemia at different CD4 count and ART status was at 8% (95%CI: 6–10%) (ranged between 1.7 and 33%). Body mass index (BMI) < 18.5 kg/m2, CD4 count < 100 cells, patients presenting with headache and male gender were reported by two or more articles as an important predictors of cryptococcal antigenemia.ConclusionsImplementing a targeted screening of HIV patients with low BMI, CD4 count < 100 cells, having headache and males; and treatment for asymptomatic cryptococcal disease should be considered. Additional data is needed to better define the epidemiology of cryptococcal antigenemia and its predictors in resource limited settings in order to optimize the prevention, diagnosis, and treatment strategies.
Highlights
Cryptococcosis is an opportunistic fungal infection that primarily affects people with advanced Human Immunodeficiency Virus (HIV)/ Acquired Immunodeficiency Syndrome (AIDS) and is an important cause of morbidity and mortality around the globe
The infection begins in the lungs, certainly the most common presentation of cryptococcal disease is cryptococcal meningitis (C M) which accounts for 15– 20% of all AIDS-related deaths globally, three quarter of which are in sub-Saharan Africa
The pooled prevalence of cryptococcal antigenemia among HIV infected patients at different CD4 count and antiretroviral treatment (ART) status was at 8%
Summary
Cryptococcosis is an opportunistic fungal infection that primarily affects people with advanced HIV/ AIDS and is an important cause of morbidity and mortality around the globe. By far the most common presentation of the disease is cryptococcal meningitis (CM), which leads to an estimated 15–20% of all HIV related deaths worldwide, 75% of which are in sub-Saharan Africa. Cryptococcosis is one of the most important opportunistic infections among people living with advanced AIDS having defective cellular immune component and is a major contributor to AIDS-related mortality worldwide [2]. The infection begins in the lungs, certainly the most common presentation of cryptococcal disease is cryptococcal meningitis (C M) which accounts for 15– 20% of all AIDS-related deaths globally, three quarter of which are in sub-Saharan Africa. Screening patients for subclinical cryptococcal infection at the time of entry into ART programs using point-of-care tools like, cryptococcal antigen (CrAg) immunoassays is highly effective in identifying patients at risk of developing CM, allowing these patients to be targeted with preemptive antifungal therapy to prevent the development of severe disease and mortality [16]
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