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Cryptococcal antigenemia in anti-retroviral naïve AIDS patients: prevalence and its association with CD4 cell count

Oghomwen Favour Osazuwa1, Osilume Dirisu, Evbaguehita Okuonghae

  • 1Department of Medical Microbiology, University of Benin Teaching hospital, PMB 1111.Benin City, Nigeria. osazuwafavour@yahoo.com

Acta Medica Iranica
|July 28, 2012
PubMed

Insights

Cryptococcus neoformans antigen (crag) is prevalent in 12.7% of AIDS patients not on antiretroviral therapy (ART). Lower CD4 counts significantly increase crag positivity, highlighting the need for early screening in this vulnerable population.

Area of Science:

  • Medical Mycology
  • Infectious Diseases
  • Immunology

Background:

  • Cryptococcus neoformans is a leading cause of fungal meningitis and mortality in acquired immune deficiency syndrome (AIDS) patients.
  • Antiretroviral therapy (ART)-naïve AIDS patients with low CD4 counts are particularly susceptible to opportunistic infections.

Purpose of the Study:

  • To determine the sero-prevalence of Cryptococcus neoformans antigen (crag) in ART-naïve AIDS patients.
  • To investigate the effect of CD4+ T-cell count on crag seropositivity.

Main Methods:

  • Serum samples from 150 ART-naïve AIDS patients (CD4 count ≤ 200 cells/µL) and 40 controls (CD4 count > 200 cells/µL) were tested for crag using the cryptococcal antigen latex agglutination system (CALAS).
  • CD4 counts were measured by flow cytometry.
  • Statistical analysis was performed to assess associations between crag positivity, CD4 count, age, and sex.

Main Results:

  • A prevalence of 12.7% for serum crag was found in ART-naïve AIDS patients.
  • The highest prevalence of crag was observed in patients with CD4 counts ≤ 50 cells/µL.
  • Lower CD4 counts were significantly associated with crag positivity (P<0.001).
  • Serum crag was significantly associated with AIDS (P<0.001) but not with HIV infection alone.

Conclusions:

  • There is a high prevalence of serum crag in ART-naïve AIDS patients in Benin City, Nigeria.
  • Routine screening for crag in ART-naïve AIDS patients is crucial for early detection and intervention to reduce mortality.
  • Lower CD4 counts are a critical risk factor for Cryptococcus neoformans infection in this population.

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