Cryptococcal antigenemia and its predictors among HIV infected patients in resource limited settings: a systematic
Awoke Derbie1,2,3, Daniel Mekonnen4,5, Yimtubezinash Woldeamanuel6,7
1Department of Medical Microbiology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia. awoke.derbie@bdu.edu.et.
Background:
Cryptococcosis is an opportunistic fungal infection that primarily affects people with advanced HIV/AIDS and is an important cause of morbidity and mortality around the globe. By far the most common presentation of the disease is cryptococcal meningitis (CM), which leads to an estimated 15-20% of all HIV related deaths worldwide, 75% of which are in sub-Saharan Africa. However, to the best of our knowledge there is quite limited reviewed data on the epidemiology of cryptococcal antigenemia in a large HIV-infected population in resource limited settings.
Methods:
Articles published in English irrespective of the time of publication were systematically searched using comprehensive search strings from PubMed/Medline and SCOPUS. In addition, Google Scholar and Google databases were searched manually for grey literature. Two reviewers independently assessed study eligibility, extracted data, and assessed risk of bias. The pooled prevalence of cryptococcal antigenemia was determined with 95% confidence interval (CI).
Results:
Among 2941 potential citations, we have included 22 studies with a total of 8338 HIV positive individuals. The studies were reported in ten different countries during the year (2007-2018). Most of the articles reported the mean CD4 count of the participants below 100 cells/μl. The pooled prevalence of cryptococcal antigenemia at different CD4 count and ART status was at 8% (95%CI: 6-10%) (ranged between 1.7 and 33%). Body mass index (BMI) < 18.5 kg/m2, CD4 count < 100 cells, patients presenting with headache and male gender were reported by two or more articles as an important predictors of cryptococcal antigenemia.
Conclusions:
Implementing a targeted screening of HIV patients with low BMI, CD4 count < 100 cells, having headache and males; and treatment for asymptomatic cryptococcal disease should be considered. Additional data is needed to better define the epidemiology of cryptococcal antigenemia and its predictors in resource limited settings in order to optimize the prevention, diagnosis, and treatment strategies.
Insights
Cryptococcal antigenemia affects 8% of HIV-positive individuals, with low BMI, CD4 count <100, headache, and male gender as key predictors. Targeted screening and early treatment are crucial for prevention in resource-limited settings.
Area of Science:
- Infectious Diseases
- Epidemiology
- Mycology
Background:
- Cryptococcosis, particularly cryptococcal meningitis (CM), is a major cause of mortality in individuals with advanced HIV/AIDS.
- Sub-Saharan Africa bears a disproportionate burden of HIV-related deaths due to CM.
- Limited data exists on the epidemiology of cryptococcal antigenemia in large HIV-infected populations in resource-limited settings.
Purpose of the Study:
- To systematically review and determine the pooled prevalence of cryptococcal antigenemia in HIV-positive individuals.
- To identify predictors of cryptococcal antigenemia in resource-limited settings.
Main Methods:
- Systematic literature search of PubMed/Medline, SCOPUS, Google Scholar, and Google databases.
- Independent review of study eligibility, data extraction, and risk of bias assessment by two reviewers.
- Pooled prevalence calculation with 95% confidence interval (CI).
Main Results:
- Included 22 studies with 8338 HIV-positive individuals from ten countries (2007-2018).
- Pooled prevalence of cryptococcal antigenemia was 8% (95% CI: 6-10%), with a range of 1.7% to 33%.
- Predictors included low body mass index (BMI <18.5 kg/m²), CD4 count <100 cells/μl, headache, and male gender.
Conclusions:
- Targeted screening for cryptococcal antigenemia in HIV patients with identified risk factors (low BMI, CD4 <100, headache, male gender) is recommended.
- Consideration for treating asymptomatic cryptococcal disease is advised.
- Further research is needed to optimize prevention, diagnosis, and treatment strategies in resource-limited settings.
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