Implementation of a rapid diagnostic assay package for cryptococcosis, histoplasmosis and tuberculosis in people living with HIV in Paraguay.

Autor: Aguilar G; National HIV Program, Asunción, Paraguay.; Facultad de Ciencias de la Salud, Universidad Sudamericana, Amambay, Paraguay., Lopez G; National HIV Program, Asunción, Paraguay., Sued O; Communicable Diseases Prevention, Control, and Elimination and Environmental Determinants of Health Department, Pan American Health Organization, 525 23rd St. NW, 20037, Washington, DC, USA., Medina N; Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases (DFWED), ASRT, Inc., Centers for Disease Control and Prevention, 30333, Atlanta, GA, USA., Caceres DH; IMMY, Inc., 73069, Norman, OK, USA.; Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia., Pereira J; Centro de Especialidades Dermatológicas, Ministerio de Salud Pública y Bienestar Social, San Lorenzo, Paraguay., Jordan A; Mycotic Diseases Branch-Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA., Lezcano V; Instituto de Medicina Tropical, Asunción, Paraguay., Vicenti C; Instituto de Medicina Tropical, Asunción, Paraguay., Benitez G; Instituto de Medicina Tropical, Asunción, Paraguay., Samudio T; National HIV Program, Asunción, Paraguay., Perez F; Communicable Diseases Prevention, Control, and Elimination and Environmental Determinants of Health Department, Pan American Health Organization, 525 23rd St. NW, 20037, Washington, DC, USA. perezf@paho.org.; Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil. perezf@paho.org.
Jazyk: angličtina
Zdroj: BMC infectious diseases [BMC Infect Dis] 2024 Apr 16; Vol. 24 (1), pp. 406. Date of Electronic Publication: 2024 Apr 16.
DOI: 10.1186/s12879-024-09257-5
Abstrakt: Background: Opportunistic infections (OIs) are common causes of mortality among people living with HIV (PLHIV). We determined prevalence and 30-day mortality due to histoplasmosis, cryptococcosis, and TB in PLHIV with advanced HIV disease (AHD).
Methods: PLHIV 18 years and older, with a CD4 + T-cell count of less than 350 cells/mm3 newly diagnosed with HIV infection or re-engaged in care after being without ART for more than 90 days (Group A). The second group included symptomatic PLHIV regardless of ART status or CD4 + T-cell count (Group B); all followed for 30 days. Detection of Histoplasma Ag (HisAg) in urine was done by enzyme immunoassay (EIA), Cryptococcus antigen (CrAg) was detected in serum and cerebrospinal fluid (CSF) specimens by lateral flow assay (LFA), and lipoarabinomannan (LAM) detection in urine was by LFA (TB LAM) and in sputum by GeneXpert for diagnosis of Mycobacterium infections.
Results: From August 2021 to June 2022, 491 PLHIV were enrolled; 482 (98%) had a CD4 + T-cell result, and 381 patients (79%) were classified with AHD according to CD4 + T-cell count (< 200 CD4/mm 3 ). Frequency of an OI was 38% (n = 145/381). Antigen test positivity rate was 16% (72/467) for TB-LAM, 9% (43/464) for HisAg, and 11% (51/484) for CrAg. Twenty-one of 34 (62%) patients receiving CSF CrAg tests were positive, confirming meningitis. Significant differences in 30-day mortality were observed in patients with an OI (16%) vs. no OI (7%) (p = 0.002). Mortality was highest in patients with histoplasmosis (25%), co-infection (22%), cryptococcosis (18% overall; 19% for cryptococcal meningitis), and TB (10%).
Conclusions: TB and fungal OIs, including co-infection, were common in PLHIV in Paraguay and had high associated mortality. Laboratories and health facilities need access to CD4 + T-cell testing and rapid diagnostic assays.
(© 2024. The Author(s).)
Databáze: MEDLINE
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