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Evaluation of screening and treatment of cryptococcal antigenaemia among HIV-infected persons in Soweto, South Africa.

Authors :
Govender, NP
Roy, M
Mendes, JF
Zulu, TG
Chiller, TM
Karstaedt, AS
Source :
HIV Medicine. Sep2015, Vol. 16 Issue 8, p468-476. 9p.
Publication Year :
2015

Abstract

Objectives We retrospectively evaluated clinic-based screening to determine the prevalence of cryptococcal antigenaemia and management and outcome of patients with antigenaemia. Methods Cryptococcal antigen ( CrAg) screening of HIV-infected adults who attended the HIV clinic at Chris Hani Baragwanath Hospital was conducted over 19 months. Data collected from CrAg-positive patients included CD4 T-lymphocyte count at screening, prior or subsequent cryptococcal meningitis ( CM), antifungal and antiretroviral treatment and outcome after at least 8 months. Results Of 1460 patients with no prior CM, 30 (2.1%) had a positive CrAg test. The prevalence of antigenaemia among patients with a CD4 count < 100 cells/μl and no prior CM was 2.8% (20 of 708). Of 29 evaluable CrAg-positive patients with no prior CM, 14 (48%) did not return for post-screening follow-up. Of these 14, five developed CM and one (7%) was known to be alive at follow-up. Of 15 patients who returned for follow-up, two already had evidence of nonmeningeal cryptococcosis. Overall, 11 received fluconazole, one did not and fluconazole treatment was unknown for three. Among these 15, one developed CM and 10 (67%) were known to be alive at follow-up. Overall, 18 (62%) of 29 CrAg-positive patients died or were lost to follow-up. Seven (0.5%) of 1430 CrAg-negative patients developed CM a median of 83 days post-screening (range 34 to 219 days). Conclusions Loss to follow-up is the major operational issue relevant to scale-up of screen-and-treat. Patient outcomes may be improved by rapid access to CrAg results and focus on linkage to and retention in HIV care. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
14642662
Volume :
16
Issue :
8
Database :
Academic Search Index
Journal :
HIV Medicine
Publication Type :
Academic Journal
Accession number :
108742375
Full Text :
https://doi.org/10.1111/hiv.12245