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Brief Report: Geographical Variation in Prevalence of Cryptococcal Antigenemia Among HIV-Infected, Treatment-Naive
Echezona E Ezeanolue1, Chidi Nwizu, Gregory S Greene
1*Global Health Initiative, School of Community Health Sciences, University of Nevada Las Vegas, Las Vegas, NV; †Department of Pediatrics, University of Nevada School of Medicine, Las Vegas, NV; ‡Centre for Clinical Care and Clinical Research, Nigeria (CCCRN), Abuja, Nigeria; §Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA; ‖Nigerian Army Reference Hospital, Lagos, Nigeria; ¶Department of Medicine, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria; #Institute of Human Virology Nigeria, Abuja, Nigeria; and **Department of Microbiology and Immunology, University of Nevada School of Medicine, Reno, NV.
Objective:
Worldwide, HIV-associated cryptococcal meningitis affects approximately 1 million persons and causes 600,000 deaths each year mostly in sub-Saharan Africa. Limited data exist on cryptococcal meningitis and antigenemia in Nigeria, and most studies are geographically restricted. We determined the prevalence of cryptococcal antigenemia (CrAg) among HIV-infected, treatment-naive individuals in Nigeria.
Design/Methods:
This was a retrospective, cross-sectional study across 4 geographic regions in Nigeria. We performed CrAg testing using a lateral flow immunoassay on archived whole-blood samples collected from HIV-infected participants at US President's Emergency Plan for AIDS Relief (PEPFAR)-supported sites selected to represent the major geographical and ethnic diversity in Nigeria. Eligible samples were collected from consenting patients (>15 years) naive to antiretroviral therapy with CD4 count less than 200 cells per cubic millimeter and were stored in an -80°C freezer.
Results:
A total of 2752 stored blood samples were retrospectively screened for CrAg. Most of the samples were from participants aged 30-44 years (57.6%), and 1570 (57.1%) were from women. The prevalence of CrAg positivity in specimens with CD4 <200 cells per cubic millimeter was 2.3% (95% confidence interval: 1.8% to 3.0%) and varied significantly across the 4 regions (P < 0.001). At 4.4% (3.2% to 5.9%), the South East contained the highest prevalence.
Conclusions:
The significant regional variation in CrAg prevalence found in Nigeria should be taken into consideration as plans are made to integrate routine screening into clinical care for HIV-infected patients.
