Utility of urine and serum lateral flow assays to determine the prevalence and predictors of cryptococcal antigenemia in HIV-positive outpatients beginning antiretroviral therapy in Mwanza, Tanzania

Autor:	Jennifer A. Downs, Daniel W. Fitzgerald, Awilly A Chofle, Shikha W. Kapoor, Kinanga A Magambo, Jeremiah Seni, Samuel E. Kalluvya
Rok vydání:	2014
Předmět:	Adult Male Serum medicine.medical_specialty Point-of-Care Systems Short Report Cryptococcus HIV Infections Urine Tanzania Asymptomatic Chromatography Affinity Mwanza Acquired immunodeficiency syndrome (AIDS) Risk Factors Internal medicine Outpatients Prevalence medicine Humans Antigens Viral Asymptomatic Infections Subclinical infection biology Diagnostic Tests Routine business.industry Public Health Environmental and Occupational Health HIV lateral flow assay Cryptococcosis Gold standard (test) biology.organism_classification medicine.disease 3. Good health Cross-Sectional Studies Infectious Diseases outpatient Immunology Female medicine.symptom business cryptococcal antigenemia Fluconazole medicine.drug
Zdroj:	Journal of the International AIDS Society
ISSN:	1758-2652
DOI:	10.7448/ias.17.1.19040
Popis:	Background : Detection of subclinical cryptococcal disease using cryptococcal antigen screening among HIV-positive individuals presents a potential opportunity for prevention of both clinical disease and death if patients with detectable cryptococcal antigen are identified and treated pre-emptively. Recently developed point-of-care cryptococcal antigen tests may be useful for screening, particularly in resource-limiting settings, but few studies have assessed their utility. Methodology : The objectives of this study were to determine the prevalence and factors associated with cryptococcal antigenemia in HIV-positive patients with CD4 + T-cell counts ≤200 cells/µL who were initiating ART, and also to evaluate the utility of the point-of-care urine lateral flow assay (LFA) cryptococcal antigen test using two different diluents, compared to gold standard serum antigen testing, as a screening tool. Urine and serum of outpatients initiating antiretroviral therapy at two hospitals in Mwanza were tested for cryptococcal antigen, and demographic and clinical characteristics were obtained using structured questionnaires and patients’ files. Patients with asymptomatic cryptococcal antigenemia received oral fluconazole in accordance with World Health Organization recommendations. Results : Among 140 patients screened, 10 (7.1%) had asymptomatic cryptococcal antigenemia with a positive serum cryptococcal antigen. Four of these ten patients had CD4 counts between 100 and 200 cells/µL. The prevalence of cryptococcal antigen detected in urine using a standard (older) and a test (newer) diluent were 44 (31.4%) and 19 (13.6%), with Kappa coefficients compared to serum of 0.28 and 0.51 ( p
Databáze:	OpenAIRE
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