Serum cryptococcal antigen testing in immunosuppressed HIV-positive children and adolescents

Abstract

Background: Describe the epidemiology of immunocompromised HIV-infected paediatric (children and adolescents <19 years) and adults (>19 years) with positive serum Cryptococcal Antigen Lateral Flow Assay (CrAg-LFA) in KwaZulu-Natal (KZN). Methods & Materials Design: Retrospective review of laboratory-based database and clinical charts Methods: A review of the National Health Laboratory Services (NHLS) database of all serum CrAg-LFA performed in KZN between June 2015-December 2016 and comparison of the epidemiology of paediatric and adult patients was conducted. A reflex serum CrAg-LFA (IMMY CrAg® LFA) was performed on samples with CD4 counts <100 cells/μL. Charts of all paediatric patients with a positive CrAgLFA at Prince Mshyeni Memorial Hospital (PMMH) were reviewed and 1 year outcome assessed. Results: A total of 22,741 laboratory records were retrieved and 1140 records were removed due to duplicate entries (1074) and insufficient data (64). There was a statistically significant difference in the incidence of positive CrAg-LFA in paediatrics and adults respectively (40 (3.5%) vs 1194 (5.8%), p = 0.001). The incidence of positive CrAg-LFA in Ethekwini district was 59 and 56 cases per 100,000 persons in adolescents 10–14 years and 15–19 years respectively. Six of the eight patients with available treatment history were on antiretroviral treatment (ART) with immune failure at the time of CrAg-LFA testing. Conclusion: Severe immune suppression in adolescents on ART is a risk factor for cryptococcal antigenaemia. A concerted effort to timeously manage ART failure in adolescents with appropriate changing of ART regimens is urgently warranted.