Screening for cryptococcal antigen in asymptomatic PLHIV: an urgent need in Eastern India
Jaya Chakravarty, Sudheer Reddy, Munesh K. Gupta, Ragini Tilak, Chakra Diwaker, Shyam Sundar- Infectious Diseases
- Immunology
- Immunology and Allergy
Objective:
Cryptococcal meningitis (CM) is a leading cause of mortality in people living with HIV (PLHIV). Despite recommendation by the National programme, Cryptococcal Antigen (CrAg) screening in PLHIV with CD4 <200/μL has not been implemented in practice. Therefore, we did a prospective study in government funded Antiretroviral treatment centre to determine the prevalence of asymptomatic cryptococcal antigenemia in PLHIV with CD4 count <200 cells/μL, subclinical cryptococcal meningitis in serum CrAg positive subjects and their outcome.
Method:
Serum CrAg (BIOSYNEX® CryptoPS) screening was done in newly diagnosed asymptomatic retro-positive adults with CD4 < 200/μL between January 2021- March 2022. We also did CSF CrAg testing in all PLHIV who were serum CrAg positive and appropriate therapy was instituted. All the enrolled participants were followed up till February 2023.
Result:
Among enrolled 142 PLHIV patients, 22 (15.49%) were positive for serum CrAg. Among these 22, seven (31.8%) patients had CD4 counts between 100-199 cells/μL. CSF CrAg was positive in 11 (50%) serum CrAg positive cases. Serum CrAg positivity was significantly associated with low CD4 cell counts, poor clinical stage and concomitant Pneumocystis pneumonia. However, mortality was not significantly different in Serum CrAg positive and negative PLHIV. None of the deaths in CrAg positive PLHIV was due to cryptococcal disease.
Conclusion:
Higher prevalence of cryptococcal antigenemia and subclinical CM among PLHIV with CD4 count < 200 cells/μL with good treatment outcomes with therapy reiterates the need for CrAg screening among PLHIV in Eastern India.