Author(s): Pongsai P, Atamasirikul K, Sungkanuparph S, Pongsai P, Atamasirikul K, Sungkanuparph S
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Abstract OBJECTIVE: To determine the role of serum cryptococcal antigen (SCA) for the screening of cryptococcosis in HIV-infected patients with different ranges of CD4 cell counts. METHODS: A retrospective cohort study was conducted in antiretroviral-naïve HIV-infected patients who had no symptom and had been screened with SCA in a tertiary-care hospital. Prevalence of positive SCA at different ranges of CD4 cell counts, risk factor of positive SCA, and incidence of cryptococcosis during one-year follow-up period after negative SCA were determined. RESULTS: There were 131 patients with a mean age of 38.5 years; 61.8\% were male. Median (range) CD4 was 62 (3-590) cells/mm(3). The overall prevalence of positive SCA was 9.2\%. This prevalence in patients with CD4 < 100, 100-199, and >or=200 cells/mm(3) were 12.9\%, 3.6\%, and 0\%, respectively (P = 0.041). In multivariate analysis, CD4 < 100 cells/mm(3) was associated with positive SCA (OR = 6.69; 95\% CI, 1.03-23.56). Four (33.3\%) of 12 patients with positive SCA had cryptococcosis whereas one (0.8\%) of 119 patients with negative SCA developed meningitis at one-year follow-up. CONCLUSIONS: SCA screening has a substantial role for the early detection of cryptococcal infection in HIV-infected patients with low CD4 cell counts. Routine screening with SCA should be performed in patients with CD4 < 100 cells/mm(3). Copyright (c) 2010 The British Infection Society. Published by Elsevier Ltd. All rights reserved.
This article was published in J Infect
and referenced in Journal of AIDS & Clinical Research