The Prevalence of Cryptococcal Antigenemia in Serum of Human Immunodeficiency Viruses-infected Patients of Iran

Abstract

BACKGROUND: Cryptococcus species are the most prevalent opportunistic agents found in patients with HIV which may result in life-threatening cryptococcal meningitis (CM). A non-invasive way for diagnosis of CM is the detection of cryptococcal antigen (CrAg) in the blood to reduce either the mortality rate or the treatment complications associated with antiretroviral therapy. Not much information is available in CM among HIV patients in Iran.
 AIM: Thus, in the current study, we aimed to evaluate the prevalence of cryptococcal disease by antigen testing, possible associated factors, and outcomes in HIV-infected patients being managed in a referral HIV/TB hospital in Tehran-Iran.
 METHODS: In this cross-sectional study, blood samples were screened for CrAg using a rapid latex agglutination test between 2017 and 2018 at Masih Daneshvari Hospital (Tehran-Iran) as referral land center for HIV/TB patients. Based on CD4 counts, 106 HIV-positive infected patients including 101 (95.3%) males and 5 (4.7%) females with the mean ± standard deviation age of 42.40 ± 10.687 and 36.50 ± 6.403 years enrolled in the study. The patients were categorized into 4 groups, (a) <50, (b) 50–100, (c) 101–200, and (d)>200 CD4+ T cells/μL. Whole blood was obtained with EDTA (for flow cytometry of CD4 counts) or without for harvesting serum for determination of CrAg in serum.
 RESULTS: The results showed only one positive case for CrAg, indicating that CrAg is rare in Iranian HIV patients (overall estimation is lower than 0.01%).
 CONCLUSIONS: With the paucity of information about the prevalence of cryptococcosis in Iran, there is a need for better screening tests and strategies for detection of CrAg in addition to the prevention and treatment approaches of CM.