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DC Field | Value | Language |
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dc.contributor.author | Letang, Emilio | - |
dc.contributor.author | Muller, Matthias C. | - |
dc.contributor.author | Ntamatungiro, Alex J. | - |
dc.contributor.author | Kimera, Namvua | - |
dc.contributor.author | Faini, Diana | - |
dc.contributor.author | Furrer, Hansjakob | - |
dc.contributor.author | Battegay, Manuel | - |
dc.contributor.author | Tanner, Marcel | - |
dc.contributor.author | Hatz, Christoph | - |
dc.contributor.author | Boulware, David R. | - |
dc.contributor.author | Glass, Tracy R. | - |
dc.date.accessioned | 2016-02-04T13:40:23Z | - |
dc.date.available | 2016-02-04T13:40:23Z | - |
dc.date.issued | 2015-04-02 | - |
dc.identifier.issn | 2328-8957 | - |
dc.identifier.uri | http://hdl.handle.net/2445/69258 | - |
dc.description.abstract | Background. Cryptococcal meningitis is a leading cause of death in people living with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome. The World Health Organizations recommends pre-antiretroviral treatment (ART) cryptococcal antigen (CRAG) screening in persons with CD4 below 100 cells/microL. We assessed the prevalence and outcome of cryptococcal antigenemia in rural southern Tanzania. Methods. We conducted a retrospective study including all ART-naive adults with CD4 <150 cells/microL prospectively enrolled in the Kilombero and Ulanga Antiretroviral Cohort between 2008 and 2012. Cryptococcal antigen was assessed in cryopreserved pre-ART plasma. Cox regression estimated the composite outcome of death or loss to follow-up (LFU) by CRAG status and fluconazole use. Results. Of 750 ART-naive adults, 28 (3.7%) were CRAG-positive, corresponding to a prevalence of 4.4% (23 of 520) in CD4 <100 and 2.2% (5 of 230) in CD4 100-150 cells/microL. Within 1 year, 75% (21 of 28) of CRAG-positive and 42% (302 of 722) of CRAG-negative patients were dead or LFU (P<.001), with no differences across CD4 strata. Cryptococcal antigen positivity was an independent predictor of death or LFU after adjusting for relevant confounders (hazard ratio [HR], 2.50; 95% confidence interval [CI], 1.29-4.83; P = .006). Cryptococcal meningitis occurred in 39% (11 of 28) of CRAG-positive patients, with similar retention-in-care regardless of meningitis diagnosis (P = .8). Cryptococcal antigen titer >1:160 was associated with meningitis development (odds ratio, 4.83; 95% CI, 1.24-8.41; P = .008). Fluconazole receipt decreased death or LFU in CRAG-positive patients (HR, 0.18; 95% CI, .04-.78; P = .022). Conclusions. Cryptococcal antigenemia predicted mortality or LFU among ART-naive HIV-infected persons with CD4 <150 cells/microL, and fluconazole increased survival or retention-in-care, suggesting that targeted pre-ART CRAG screening may decrease early mortality or LFU. A CRAG screening threshold of CD4 <100 cells/microL missed 18% of CRAG-positive patients, suggesting guidelines should consider a higher threshold. | - |
dc.format.extent | 8 p. | - |
dc.format.mimetype | application/pdf | - |
dc.language.iso | eng | - |
dc.publisher | Oxford University Press | - |
dc.relation.isformatof | Reproducció del document publicat a: http://dx.doi.org/10.1093/ofid/ofv046 | - |
dc.relation.ispartof | Open Forum Infectious Diseases, 2015, vol. 2, num. 2, p. 1-8 | - |
dc.relation.uri | http://dx.doi.org/10.1093/ofid/ofv046 | - |
dc.rights | cc by-nc-nd (c) Letang et al., 2015 | - |
dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/3.0/es/ | - |
dc.source | Articles publicats en revistes (ISGlobal) | - |
dc.subject.classification | Comorbiditat | - |
dc.subject.classification | Meningitis | - |
dc.subject.classification | Infeccions per VIH | - |
dc.subject.classification | Micologia mèdica | - |
dc.subject.other | Comorbidity | - |
dc.subject.other | Meningitis | - |
dc.subject.other | HIV infections | - |
dc.subject.other | Medical mycology | - |
dc.title | Cryptococcal Antigenemia in Immunocompromised Human Immunodeficiency Virus Patients in Rural Tanzania: A Preventable Cause of Early Mortality | - |
dc.type | info:eu-repo/semantics/article | - |
dc.type | info:eu-repo/semantics/publishedVersion | - |
dc.date.updated | 2016-02-02T15:35:03Z | - |
dc.rights.accessRights | info:eu-repo/semantics/openAccess | - |
dc.identifier.pmid | 26213690 | - |
Appears in Collections: | Articles publicats en revistes (ISGlobal) |
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letang2015_1943.pdf | 266.77 kB | Adobe PDF | View/Open |
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