Prevalence of Cryptococcaemia in HIV Seropositive Patients in an Indian Setting

Abstract

Introduction: Cryptococcal infection is the most common opportunistic fungal infection was seen in HIV patients. Despite specific treatment, mortality due to cryptococcaemia still remains high primarily because of late diagnosis. Therefore, studies have recommended that routine screening is cost-effective in patients with CD4 count ≤100 cells/mm3 in areas with cryptococcal antigenemia >0.6%. Prevalence of cryptococcaemia in India is reported to be variable and therefore, whether routine screening for cryptococcal infection is cost-effective or not, cannot be ascertained. Aim: To find out the prevalence of cryptococcaemia in HIV infected patients with CD4 counts of ≤100 cells/mm3 . Materials and Methods: This was a cross-sectional study, conducted at KEM hospital, Mumbai, India which is a tertiary care hospital, all HIV infected patients with CD4 count ≤100 cells/mm3 coming to the hospital between January 2015 and December 2015 were enrolled. Blood samples drawn were processed for wet mount, negative staining with India ink, gram staining, fungal culture and Cryptococcal Antigen (CrAg) Lateral Flow Assay (LFA) using IMMY LFA Kit. Statistical calculation was done using SPSS software Version 20.0 (SPSS Inc. Chicago, IL, USA) and chi-square and Fisher-exact test was used to compare categorical variables. Results: Out of 150 patients enrolled, 23 (15.3%) had CD4 count below 50, while 127 (84.7%) had between 51-100. 108 patients (72%) were Anti-Retroviral Therapy (ART) experienced and 42 (28%) were ART naïve. An amount of 53.3% of patients had no opportunistic infections, 27.3% had pulmonary tuberculosis, 11.3% had candidiasis and 8% had extra-pulmonary tuberculosis. Four samples tested positive for LFA giving a prevalence of 2.67%, while none of the cultures were positive for Cryptococcus species. No significant association was seen between age and gender to positive serum cryptococcal antigenemia. However, low CD4 count was found to be strongly co-related to positive serum cryptococcal antigenemia. Conclusion: This study reveals that cryptococcal antigenemia is a health problem and Cryptococcal antigen screen and treat policy recommended by World Health Organisation should be made routine for HIV patients registering at ART centre in the present setting especially those who are ART naive and have CD4 counts ≤100 cells/mm3 .

Keywords

• cd4 count
• cryptococcal infection
• hiv infection
• screening