Abstract
Cryptococcosis is a life-threatening fungal infection that presents diversely with no specific pathognomonic features. Cryptococcal disease is one of the most important opportunistic infections, and a significant contributor to early mortality in HIV infected subjects. Cryptococcal antigenemia occurs in Nigeria, but the magnitude of this disease remains unclear. This study was carried out to determine the prevalence of CrAg among HIV infected and HIV seronegative subjects and to assess the relationship between CD4 count and CrAg in HIV-positive subjects attending Adeoyo Maternity Teaching Hospital, Yemetu, Ibadan. In an hospital-based case-control study using simple random sampling, 114 HIV-seropositive individuals (cases) and 228 HIV-seropositive individuals (controls) were recruited. A semi-structured interviewer-administered questionnaire was used to collect data from subjects and retrospective review of CD4 count records in HIV infected subjects. Five millilitres of venous blood were collected from each participant. Serum Cryptococcal antigen testing was done using CrAg Lateral Flow Assay. Data was analyzed using descriptive statistics and bivariate analysis at 5% level of significance. Mean age of cases was 41.2 ± 10.0 years and 85 (74.6%) were females while mean age of controls was 38.9 ± 13.7 years and 156 (68.4%) were females. The prevalence of CrAg among cases was 11.4% and 7.0% among controls. Cases were about two times more likely to test positive for CrAg. However, the association was not statistically significant (OR: 1.71, 95%CI: 0.79 - 3.68). Individuals with CD4 counts of ≤100 cells/µl were 20 times more likely to have positive serum cryptococcal antigen than individuals with CD4 counts >100 cells/µl (OR: 20.3, 95%CI: 5.23-78.9). This study has demonstrated significant prevalence of Cryptococcal antigenemia among the study population; however, prevalence was higher among cases. Screening for CrAg should therefore be part of routine tests amongst all confirmed HIV seropositive cases, since asymptomatic cryptococcal antigenemia predicts impending cryptococcal infection with probable mortality.
Highlights
Cryptococcosis is an infection with the fungusCryptococcus
This study has demonstrated significant prevalence of Cryptococcal antigenemia among the study population; prevalence was significantly higher among cases
Thirteen (11.4%) participants tested positive for serum cryptococcal antigen among cases while sixteen (7.0%) participants tested positive for serum cryptococcal antigen among controls
Summary
It is a serious opportunistic infection among people with compromised immune systems, such as those with advanced HIV/AIDS. Cryptococcal meningitis is the second most common life-threatening HIV-associated opportunistic infection after tuberculosis and may be responsible for up to 20% of deaths in resource limited settings. Available data shows that the prevalence of Cryptococcus neoformans infection among HIVinfected patients is up to 40% in most parts of the world in sub-Saharan Africa and Southeast Asia which are considered the epicenters of the HIV/AIDS pandemic [10]. Diagnosis of HIV occurs at a late stage and treatment coverage in the country is relatively low With these challenges, patients continue to die of HIV-related opportunistic infections (OIs) in the weeks prior to and months following initiation of anti-retroviral therapy (ART) [9]. This study was conducted to determine the prevalence of CrAg and to compare the CD4 count and the presence of CrAg among individuals attending Adeoyo Maternity Teaching Hospital, Yemetu, Ibadan, Oyo State
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