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Cryptococcal Antigen Screening Among Antiretroviral Therapy–Experienced People With HIV With Viral Load Nonsuppression in Rural Uganda

BACKGROUND: The World Health Organization recommends screening for the cryptococcal antigen (CrAg), a predictor of cryptococcal meningitis, among antiretroviral therapy (ART)–naïve people with HIV (PWH) with CD4 <100 cells/mm(3). CrAg positivity among ART-experienced PWH with viral load (VL) nons...

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Autores principales: Baluku, Joseph Baruch, Mugabe, Pallen, Mwebaza, Shem, Nakaweesi, Jane, Senyimba, Catherine, Opio, Joel Peter, Mukasa, Barbara
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7880263/
https://www.ncbi.nlm.nih.gov/pubmed/33604402
http://dx.doi.org/10.1093/ofid/ofab010
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author Baluku, Joseph Baruch
Mugabe, Pallen
Mwebaza, Shem
Nakaweesi, Jane
Senyimba, Catherine
Opio, Joel Peter
Mukasa, Barbara
author_facet Baluku, Joseph Baruch
Mugabe, Pallen
Mwebaza, Shem
Nakaweesi, Jane
Senyimba, Catherine
Opio, Joel Peter
Mukasa, Barbara
author_sort Baluku, Joseph Baruch
collection PubMed
description BACKGROUND: The World Health Organization recommends screening for the cryptococcal antigen (CrAg), a predictor of cryptococcal meningitis, among antiretroviral therapy (ART)–naïve people with HIV (PWH) with CD4 <100 cells/mm(3). CrAg positivity among ART-experienced PWH with viral load (VL) nonsuppression is not well established, yet high VLs are associated with cryptococcal meningitis independent of CD4 count. We compared the frequency and positivity yield of CrAg screening among ART-experienced PWH with VL nonsuppression and ART-naïve PWH with CD4 <100 cells/mm(3) attending rural public health facilities in Uganda. METHODS: We reviewed routinely generated programmatic reports on cryptococcal disease screening from 104 health facilities in 8 rural districts of Uganda from January 2018 to July 2019. A lateral flow assay (IMMY CrAg) was used to screen for cryptococcal disease. PWH were eligible for CrAg screening if they were ART-naïve with CD4 <100 cell/mm(3) or ART-experienced with an HIV VL >1000 copies/mL after at least 6 months of ART. We used Pearson’s chi-square test to compare the frequency and yield of CrAg screening. RESULTS: Of 71( )860 ART-experienced PWH, 7210 (10.0%) were eligible for CrAg screening. Among 15( )417 ART-naïve PWH, 5719 (37.1%) had a CD4 count measurement, of whom 937 (16.4%) were eligible for CrAg screening. The frequency of CrAg screening was 11.5% (830/7210) among eligible ART-experienced PWH compared with 95.1% (891/937) of eligible ART- naïve PWH (P < .001). The CrAg positivity yield was 10.5% among eligible ART-experienced PWH compared with 13.8% among eligible ART-naïve PWH (P = .035). CONCLUSIONS: The low frequency and high positivity yield of CrAg screening among ART-experienced PWH with VL nonsuppression suggest a need for VL- directed CrAg screening in this population. Studies are needed to evaluate the cost-effectiveness and impact of CrAg screening and fluconazole prophylaxis on the outcomes of ART-experienced PWH with VL nonsuppression.
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spelling pubmed-78802632021-02-17 Cryptococcal Antigen Screening Among Antiretroviral Therapy–Experienced People With HIV With Viral Load Nonsuppression in Rural Uganda Baluku, Joseph Baruch Mugabe, Pallen Mwebaza, Shem Nakaweesi, Jane Senyimba, Catherine Opio, Joel Peter Mukasa, Barbara Open Forum Infect Dis Major Articles BACKGROUND: The World Health Organization recommends screening for the cryptococcal antigen (CrAg), a predictor of cryptococcal meningitis, among antiretroviral therapy (ART)–naïve people with HIV (PWH) with CD4 <100 cells/mm(3). CrAg positivity among ART-experienced PWH with viral load (VL) nonsuppression is not well established, yet high VLs are associated with cryptococcal meningitis independent of CD4 count. We compared the frequency and positivity yield of CrAg screening among ART-experienced PWH with VL nonsuppression and ART-naïve PWH with CD4 <100 cells/mm(3) attending rural public health facilities in Uganda. METHODS: We reviewed routinely generated programmatic reports on cryptococcal disease screening from 104 health facilities in 8 rural districts of Uganda from January 2018 to July 2019. A lateral flow assay (IMMY CrAg) was used to screen for cryptococcal disease. PWH were eligible for CrAg screening if they were ART-naïve with CD4 <100 cell/mm(3) or ART-experienced with an HIV VL >1000 copies/mL after at least 6 months of ART. We used Pearson’s chi-square test to compare the frequency and yield of CrAg screening. RESULTS: Of 71( )860 ART-experienced PWH, 7210 (10.0%) were eligible for CrAg screening. Among 15( )417 ART-naïve PWH, 5719 (37.1%) had a CD4 count measurement, of whom 937 (16.4%) were eligible for CrAg screening. The frequency of CrAg screening was 11.5% (830/7210) among eligible ART-experienced PWH compared with 95.1% (891/937) of eligible ART- naïve PWH (P < .001). The CrAg positivity yield was 10.5% among eligible ART-experienced PWH compared with 13.8% among eligible ART-naïve PWH (P = .035). CONCLUSIONS: The low frequency and high positivity yield of CrAg screening among ART-experienced PWH with VL nonsuppression suggest a need for VL- directed CrAg screening in this population. Studies are needed to evaluate the cost-effectiveness and impact of CrAg screening and fluconazole prophylaxis on the outcomes of ART-experienced PWH with VL nonsuppression. Oxford University Press 2021-01-06 /pmc/articles/PMC7880263/ /pubmed/33604402 http://dx.doi.org/10.1093/ofid/ofab010 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Major Articles
Baluku, Joseph Baruch
Mugabe, Pallen
Mwebaza, Shem
Nakaweesi, Jane
Senyimba, Catherine
Opio, Joel Peter
Mukasa, Barbara
Cryptococcal Antigen Screening Among Antiretroviral Therapy–Experienced People With HIV With Viral Load Nonsuppression in Rural Uganda
title Cryptococcal Antigen Screening Among Antiretroviral Therapy–Experienced People With HIV With Viral Load Nonsuppression in Rural Uganda
title_full Cryptococcal Antigen Screening Among Antiretroviral Therapy–Experienced People With HIV With Viral Load Nonsuppression in Rural Uganda
title_fullStr Cryptococcal Antigen Screening Among Antiretroviral Therapy–Experienced People With HIV With Viral Load Nonsuppression in Rural Uganda
title_full_unstemmed Cryptococcal Antigen Screening Among Antiretroviral Therapy–Experienced People With HIV With Viral Load Nonsuppression in Rural Uganda
title_short Cryptococcal Antigen Screening Among Antiretroviral Therapy–Experienced People With HIV With Viral Load Nonsuppression in Rural Uganda
title_sort cryptococcal antigen screening among antiretroviral therapy–experienced people with hiv with viral load nonsuppression in rural uganda
topic Major Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7880263/
https://www.ncbi.nlm.nih.gov/pubmed/33604402
http://dx.doi.org/10.1093/ofid/ofab010
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