Prevalence of cryptococcal meningitis among HIV patients attending Central University Hospital of Kigali

Abstract

Background: Cryptococcal meningitis (CM) is a severe fungal infection caused primarily by Cryptococcus neoformans and less commonly by Cryptococcus gattii. It poses a significant threat to individuals with compromised immune systems, particularly those living with Human Immunodeficiency Virus (HIV). Despite advancements in antiretroviral therapy (ART), CM remains a leading cause of mortality among HIV-infected individuals, especially in low- and middle-income countries. Aim: This study was done to determine the prevalence of Cryptococcus among HIV-infected patients attending at Central University Hospital of Kigali, Rwanda and the level at which a patient’s CD4 count is significantly associated with cryptococcal meningitis. Methodology: A retrospective study was conducted at Central University Hospital of Kigali, Rwanda. This study included 60 HIV-infected patients whose serum and CSF samples were examined for Cryptococcus by one of or all 4 tests (CSF culture, CSF CrAg, serum CrAg and Indian Ink) and their results were recorded. Results: Among the 60 HIV-infected patients enrolled, 8 (13%) were positive for cryptococcal meningitis. Among these 8 patients the CD4 count ranged from 2-200 cells/ul, and 31.82% (7 of 8) was among patients with CD4 count ≤100 c/ul and 6.25% (1 of 8) was among patients with CD4 count levels between 101 c/ul and 200c/ul. Based on the study results, CD4 count levels lower or equal to 100 cells/ul was highly associated with cryptococcal meningitis as the P-value=0.001 and Odd ratio=0.058. Conclusion: Based on the study results there was a significant association between cryptococcal meningitis and lower CD4 count levels. HIV-infected patients with CD4 counts ≤100 cells had the highest prevalence. Therefore, the level of CD4 count below or equal to 100 cells/ul is highly associated with positive cryptococcal meningitis. However, there were cases of positive CM among HIV patients with CD4 count ≥100 cells/ul. Keywords: Cryptococcal meningitis, CD4 count, HIV,