Cryptococcus neoformans and PLWH: the role of serum cryptococcal antigen screening

Area of Science:

• Infectious Diseases
• Clinical Microbiology
• HIV Medicine

Background:

• Serum cryptococcal antigen (CrAg) screening is vital for early cryptococcal meningitis detection.
• This study evaluated CrAg screening outcomes in people living with HIV (PLWH) over six years.

Purpose of the Study:

• To assess the utility of serum CrAg screening in PLWH.
• To analyze CrAg test results in relation to CD4+ T cell counts and clinical outcomes.

Main Methods:

• Retrospective analysis of CrAg screening data from PLWH with CD4+ T cell counts < 200 cells/µL.
• Collected data included demographics, comorbidities, CD4+ T cell counts, HIV RNA levels, and cerebrospinal fluid (CSF) findings.
• Descriptive statistics were employed for data analysis.

Main Results:

• Serum CrAg testing was performed on 99 patients, with 9 positive results.
• Four patients with positive CrAg were diagnosed with cryptococcal meningitis; two had false-positive results.
• One patient with meningitis had a negative CrAg, and one positive case was lost to follow-up.

Conclusions:

• CrAg positivity can indicate asymptomatic cryptococcal infection.
• Screening should be considered even for PLWH with CD4+ T cell counts > 100 cells/µL.
• Careful interpretation is necessary due to potential false-positive and false-negative CrAg results.