1. Patients w/AIDS-defining illness
Address: 430 Honorio Delgado Av-San Martin de Porres-Lima 31-PERU
Phone number:
P360
Cryptococcal antigenemia in Peruvian HIV infected patients with a CD4 count ≤ 100 cell/mm3
Linares Barandiaran L1, Paz J1, Bustamante B1, 2.
1Instituto de Medicina Tropical Alexander von Humboldt-Universidad Peruana Cayetano Heredia 2Hospital Nacional Cayetano Heredia, Lima, Perú.
INTRODUCTION:
Cryptoccoccosis occurs mostly in the late stage of HIV disease with CD4 count ≤ 100 cell/mm3. Studies evaluating the utility of cryptococcal antigenemia (CrAg) screening in patients with low CD4 count before initiating HAART have been conducted in African and Asian countries, but not in Latin-America. For this reason, this study focused on determining the proportion of CrAg in HIV-infected patients, without HAART, receiving medical care at the Hospital Nacional Cayetano Heredia (HNCH), and who are participating in HIV/AIDS cohort (COVIHS).
OBJECTIVES:
Primary objective: To determine the proportion of CrAg among HIV-infected patients with CD4 of ≤ 100 cell/mm3, without HAART and no history of Cryptococcal disease, who are participating in COVIHS.
Secondary objective: To compare: i) developing of symptomatic cryptococcosis, ii) the difference in mortality and iii) the difference in episodes of AIDS-defining illness between patients with positive and negative CrAg during the 12 months follow up on HAART.
METHODS:
A retrospective study was conducted at the HNCH at Lima-Peru between June 2011 and January Stored plasma samples belonging to adults AIDS patients with baseline CD4 of ≤ 100 cell/mm3, ready to initiate HAART, without history of Cryptococcosis, and enrolled in COVIHS were tested for detection of CrAg using the CrAg Lateral Flow Assay. Enrolled patients were followed up to 12 months. Data including demographic information, past medical history, CD4 count and HAART regimen was collected.
RESULTS:
Of 368 participants, three were excluded due to past medical history of Cryptococcosis. (See Fig. 1)
Among the remaining 365 participants, the mean age was 36.6 (SD= 10.7) years the median baseline CD4 count was 41.8 (IQR: 64 to 17) cells/mm3, and 77% were male. (See Table 1.)
Thirteen plasma samples out of 365 (3.6 %, CI 95 % 1.7% to 5.5%) were CrAg positive.
The median CD4 count was lower for patients with CrAg positive (median 35.7; SD=15.8) as compared to patients without antigenemia (42.1; SD=28.4) (p=0.2).
Three out of 13 (23%) CrAg positive patients developed positive culture for Cryptococcosis, while none did among CrAg negative patients (p≤0.00). Nine out of 13 (69%) and 251 out of 352 (72%) (p =0.871), of patients developed at least one AIDS-defined complication, and there were a mean of 1.31 (17/13) and 1.72 (604/352) episodes of AIDS-defining illness per patient at each group. None patient died during the follow up.
Developed definitive cryptococcosis disease
Proportion: 3.6 %, CI 95 %: 1.7% to 5.5%
Three patients excluded due to past medical history of Cryptococcosis
368
samples
365 13
Positive CrAg
Crypto Positive culture
352
Negative CrAg 3
Excluded
Figure 1. Study profile
None
Table 1. Baseline characteristics of all participants and of those with CrAg positive (365)
Participants (n=352)
CrAg positive (n=13)
Mean age
36.5 (SD±10.7)
37.77(SD±12)
Sex
77% (male)
69% (male)
CD4 (cells/mm3) median
42.1; SD=28.4
35.7; SD=15.8
Patients w/AIDS-defining illness
69%
72%
CONCLUSION:
The proportion of Cryptococcal antigenemia in this study population was 3.6% (CI 95 %: 1.7% to 5.5%). There was not statistically significant difference in the number of patients who developed a new AIDS-defined illness between patients with positive or negative CrAg.
ACKNOWLODEGMENT:
We thank the Institute of Tropical Medicine in Antwerp, Belgium and The Caribbean, Central and South America network for HIV epidemiology (CCASAnet) (Member of the International Epidemiologic Databases to Evaluate AIDS) (IeDEA consortium) for providing support to the COVIHs and to the IMMY company to supply the CrAg Lateral Flow Assay tests. .