Screening for cryptococcal antigen in asymptomatic people with HIV: urgent need in Eastern India

Cryptococcal meningitis (CM) is a leading cause of mortality in people with HIV (PWH). Despite recommendation by the National programme, cryptococcal antigen (CrAg) screening in PWH with CD4 + <200/microl has not been implemented in practice. Therefore, we conducted a prospective study in government funded Antiretroviral treatment centre to determine the prevalence of asymptomatic cryptococcal antigenemia in PWH with CD4 + cell count <200 cells/microl, subclinical cryptococcal meningitis in serum CrAg positive subjects and their outcome.

Serum CrAg (BIOSYNEX CryptoPS) screening was conducted in newly diagnosed asymptomatic retro-positive adults with CD4 + <200/microl between January 2021 and March 2022. We also conducted cerebrospinal fluid (CSF) CrAg testing in all PWH who were serum CrAg positive and appropriate therapy was instituted. All the enrolled participants were followed up till February 2023.

Among enrolled 142 PWH patients, 22 (15.49%) were positive for serum CrAg. Among these 22, seven (31.8%) patients had CD4 + cell count between 100 and 199 cells/microl. CSF CrAg was positive in 11 (50%) serum CrAg positive cases. Serum CrAg positivity was significantly associated with low CD4 + cell count, poor clinical stage and concomitant Pneumocystis pneumonia. However, mortality was not significantly different in Serum CrAg positive and negative PWH. None of the deaths in CrAg positive PWH was due to cryptococcal disease.

Higher prevalence of cryptococcal antigenemia and subclinical CM among PWH with CD4 + cell count <200 cells/microl with good treatment outcomes with therapy reiterates the need for CrAg screening among PWH in Eastern India.