Cryptococcal antigenemia in anti-retroviral naive AIDS patients: prevalence and its association with CD4 cell count

ABSTRACT

Cryptococcus neoformans is the most incriminated fungal pathogen causing meningitis in acquired immune deficiency syndrome [AIDS] patients, and is known to constitute a major cause of deaths in AIDS patients. This study aimed to determine the sero-prevalence and effect of CD4 count on seropositivity for Cryptococcus neoformans antigen [crag] in antiretroviral- naive [ART-naive] AIDS patients. This study included 150 [61 males and 89 females] ART-naive AIDS patients attending the Human Immunodeficiency Virus [HIV] clinic of the University of Benin teaching hospital, Benin City, Nigeria within the period February 2011- July 2011. 40 [18 males and 22 females] HIV positive outpatients with CD4 counts >200 cells/microl who are ART-naive were recruited and used as controls. The prevalence of crag in the patients and control group was determined using the cryptococcal antigen latex agglutination system [CALAS] [Meridian Bioscience, Europe] and CD4 counts were measured using flow cytometry [Partec flow cytometer, Germany]. Of 150 ART-naive AIDS patients with CD4 counts cells/microL, 19 [12.7%] were positive for serum Cryptococcal antigen. ART-naive AIDS patients with CD4 count cells/microl had the highest prevalence of serum crag. Lower CD4 counts were significantly associated with positivity for serum crag [P<0.001]. Age and Sex had no significant effect on the sero-positivity for serum crag. 1 [2.5%] of the control was sero-positive for crag. Serum crag was significantly associated with AIDS but not with HIV [P<0.001]. This study uncovers a high prevalence of crag in ART-naive AIDS patients in Benin City. There is an urgent need to introduce early and routine screening for crag in ART-naive AIDS patients for prompt intervention