# name
Cryptococcal Antigenemia in Immunocompromised Human
                Immunodeficiency Virus Patients in Rural Tanzania: A Preventable
                Cause of Early Mortality

# metadata.dc.description.abstract[].value
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.

# metadata.dc.relation.ispartof[].value
Open Forum Infectious Diseases, 2015, vol. 2, num. 2, p. 1-8

# metadata.dc.source[].value
Articles publicats en revistes (ISGlobal)

# metadata.dc.title[].value
Cryptococcal Antigenemia in Immunocompromised Human
                Immunodeficiency Virus Patients in Rural Tanzania: A Preventable
                Cause of Early Mortality