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Laboratory-reflex cryptococcal antigen screening is associated with a survival benefit in Tanzania

Faini, Diana and Kalinjuma, Aneth Vedastus and Katende, Andrew and Mbwaji, Gladys and Mnzava, Dorcas and Nyuri, Amina and Glass, Tracy R. and Furrer, Hansjakob and Hatz, Christoph and Boulware, David R. and Letang, Emilio. (2019) Laboratory-reflex cryptococcal antigen screening is associated with a survival benefit in Tanzania. Journal of Acquired Immune Deficiency Syndromes, 80 (2). pp. 205-213.

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Official URL: https://edoc.unibas.ch/69178/

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Abstract

Cryptococcal antigen (CrAg) screening in persons with advanced HIV/AIDS is recommended to prevent death. Implementing CrAg screening only in outpatients may underestimate the true CrAg prevalence and decrease its potential impact. Our previous 12-month survival/retention in CrAg-positive persons not treated with fluconazole was 0%.; HIV testing was offered to all antiretroviral therapy-naive outpatients and hospitalized patients in Ifakara, Tanzania, followed by laboratory-reflex CrAg screening for CD4 <150 cells/μL. CrAg-positive individuals were offered lumbar punctures, and antifungals were tailored to the presence/absence of meningitis. We assessed the impact on survival and retention-in-care using multivariate Cox-regression models.; We screened 560 individuals for CrAg. The median CD4 count was 61 cells/μL (interquartile range 26-103). CrAg prevalence was 6.1% (34/560) among individuals with CD4 ≤150 and 7.5% among ≤100 cells/μL. CrAg prevalence was 2.3-fold higher among hospitalized participants than in outpatients (12% vs 5.3%, P = 0.02). We performed lumbar punctures in 94% (32/34), and 31% (10/34) had cryptococcal meningitis. Mortality did not differ significantly between treated CrAg-positive without meningitis and CrAg-negative individuals (7.3 vs 5.4 deaths per 100 person-years, respectively, P = 0.25). Independent predictors of 6-month death/lost to follow-up were low CD4, cryptococcal meningitis (adjusted hazard ratio 2.76, 95% confidence interval: 1.31 to 5.82), and no antiretroviral therapy initiation (adjusted hazard ratio 3.12, 95% confidence interval: 2.16 to 4.50).; Implementing laboratory-reflex CrAg screening among outpatients and hospitalized individuals resulted in a rapid detection of cryptococcosis and a survival benefit. These results provide a model of a feasible, effective, and scalable CrAg screening and treatment strategy integrated into routine care in sub-Saharan Africa.
Faculties and Departments:09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Medicine > Clinical Research (Reither)
UniBasel Contributors:Glass, Tracy and Hatz, Christoph and Letang Jimenez de Anta, Emilio Angel
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:Lippincott, Williams & Wilkins
ISSN:1525-4135
e-ISSN:1944-7884
Note:Publication type according to Uni Basel Research Database: Journal article
Identification Number:
Last Modified:26 Feb 2019 09:44
Deposited On:26 Feb 2019 09:44

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