Laboratory Reflex and Clinic-based Point-of-care Cryptococcal Antigen Screening for Preventing Meningitis and Mortality among People Living with HIV

Objective: Cryptococcal meningitis is an important cause of morbidity and mortality in HIV infected individuals. In the era of universal antiretroviral therapy incidence of immune reconstitution inflammatory syndrome (IRIS) related cryptococcal meningitis has increased. Detection of serum cryptococcal antigen in asymptomatic PLHIV (People Living With HIV) and pre-emptive treatment with fluconazole can decrease the burden of cryptococcal disease. We conducted this study to find the prevalence of asymptomatic cryptococcal antigenemia in India and its correlation with mortality in PLHIV. Method and material: This was a prospective observational study. HIV infected ART naïve patients with age of ≥ 18 years who had CD4 counts ≤ 100 /µL were included and serum cryptococcal antigen test was done. These patients were followed for six months to look for the development of Cryptococcal meningitis and mortality. Results: A total of 116 patients were analysed. Asymptomatic cryptococcal antigenemia was detected in 5.17% patients and it correlated with increased risk of cryptococcal meningitis and mortality on follow-up in PLHIV. Conclusion: Serum cryptococcal positivity is correlated with increased risk of Cryptococcal meningitis and mortality in PLHIV. We recommend the screening of asymptomatic PLHIV with CD4 ≤ 100/µL for serum cryptococcal antigen, so that pre-emptive treatment can be initiated to reduce morbidity and mortality.

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Impact of hematocrit on point-of-care C-reactive protein-based tuberculosis screening among people living with HIV initiating antiretroviral therapy in Uganda

Diagnostic Microbiology and Infectious Disease ◽

10.1016/j.diagmicrobio.2020.115281 ◽

2020 ◽

pp. 115281

Author(s):

Sandra Z. Mwebe ◽

Christina Yoon ◽

Lucy Asege ◽

Martha Nakaye ◽

Jane Katende ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Point Of Care ◽

People Living With Hiv ◽

C Reactive Protein ◽

Tuberculosis Screening ◽

Reactive Protein ◽

Living With Hiv

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Cryptococcal antigen carriage among HIV infected children aged 6 months to 15 years at Laquintinie Hospital in Douala

PLoS ONE ◽

10.1371/journal.pone.0253781 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0253781

Author(s):

Ginette Claude Mireille Kalla ◽

Josette Farida Mboumnyemb ◽

Jules Clément Nguedia Assob ◽

Marcelle Nina Ehouzou Mandeng ◽

Nelly Kamgaing Noubi ◽

...

Keyword(s):

Strong Association ◽

Cross Sectional Study ◽

Sub Saharan Africa ◽

World Health ◽

Treatment Center ◽

People Living With Hiv ◽

Cross Sectional ◽

Cryptococcal Antigen ◽

Severe Immunosuppression ◽

Living With Hiv

Background Up to 15% of deaths of people living with HIV is attributable to meningeal cryptococcosis, with nearly 75% occuring in sub-Saharan Africa. Although rare in children, it is a major cause of morbidity and mortality in people living with HIV. A strong association between cryptococcal antigenemia and the development of meningeal cryptococcosis has been shown in adults. Thus, in 2018, the World Health Organization published an updated version of its guidelines for the diagnosis, prevention and management of cryptococcal infection in adults, adolescents and the HIV-infected child. Goal To determine the prevalence of cryptococcal antigenemia and to identify its determinants in children infected with HIV. Methods An analytical cross-sectional study was carried out at the approved treatment center of Laquintinie hospital in Douala over a period of 4 months. Children were recruited consecutively after informed parental consent. Cryptococcal antigenemia and CD4 assay were performed using a Cryptops® immunochromatographic rapid diagnostic test and flow cytometry, respectively. The data collected included the socio-demographic, clinical and paraclinical variables of the children, as well as their antecedents. Data analysis was performed using Epiinfo software version 3.1 and SPSS 21.0. The significance threshold was set at 5%. Results A total of 147 children were enrolled. The mean age was 9.8 ± 4.09 years. The majority were on antiretroviral therapy (142, 96.60%). Only 13 (8.80%) were in severe immunosuppression. No child showed signs of meningeal cryptococcosis. The prevalence of cryptococcal antigenemia was 6.12%. Severe immunosuppression [OR: 10.03 (1.52–65.91), p = 0.016] and contact with pigeons [OR: 9.76 (1.14–83.65), p = 0.037] were independent factors significantly associated with the carriage of the cryptococcal antigen. Conclusion We recommend screening for cryptococcal antigenemia and routine treatment with fluconazole of all HIV positive children with cryptococcal antigen whether symptomatic or not.

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Prevalence of Cryptococcal Antigen and outcomes in people living with HIV in Honduras: A cohort study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa557 ◽

2020 ◽

Author(s):

Julio C Zuniga-Moya ◽

Luis Enrique Romero-Reyes ◽

Emilio Barrueto Saavedra ◽

Sandra Montoya ◽

Diana Varela ◽

...

Keyword(s):

Cohort Study ◽

Central America ◽

People Living With Hiv ◽

Cryptococcal Antigen ◽

Risk Of Death ◽

Cox Proportional Hazard ◽

Asymptomatic Patients ◽

High Incidence ◽

Cox Proportional Hazard Models ◽

Living With Hiv

Abstract Background Cryptococcal meningitis is a major cause of death among people living with HIV (PLWH). Cryptococcal antigen (CrAg) testing of asymptomatic patients is an important public health measure to reduce mortality in high incidence areas. However, limited data exists on CrAg prevalence in Central America. Methods We conducted a prospective cohort study at the two largest HIV clinics and hospitals in Honduras. CrAg in serum and cerebrospinal fluid was performed in individuals living with HIV who had CD4 ≤ 100 cells/mm 3 between 2017-2018. After CrAg testing, individuals were followed up for 12 months to assess mortality using adjusted cox proportional hazard models. Results A total of 220 PLWH were tested for CrAg of which 12.7% (n=28) tested positive. CrAg prevalence was higher among hospitalized individuals in 40% (n=10 of 25) of the cases. The proportion (35.8%) of individuals taking ART was significantly (p<0.01) lower among those who tested positive for CrAg. Overall mortality among the cohort was 11.4% (n=25 of 220) by 12 months. CrAg-positive cases were at a significantly higher risk of death [aHR: 2.69, 95%: 1.07-6.84] when compared to CrAg-negative participants. Conclusions CrAg prevalence in Honduras was high among PLWH. Moreover, individuals who tested positive for CrAg testing were at a higher risk of death. Systemic CrAg of PLWH with a CD4 ≤ 100 cells/mm 3 should be routinely performed in Central America.

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Costs of Point-of-Care Viral Load Testing for Adults and Children Living with HIV in Kenya

Diagnostics ◽

10.3390/diagnostics11010140 ◽

2021 ◽

Vol 11 (1) ◽

pp. 140

Author(s):

Michelle Ann Bulterys ◽

Patrick Oyaro ◽

Evelyn Brown ◽

Nashon Yongo ◽

Enericah Karauki ◽

...

Keyword(s):

Viral Load ◽

Laboratory Testing ◽

Point Of Care ◽

Treatment Monitoring ◽

Hiv Care ◽

People Living With Hiv ◽

Capital Costs ◽

Adults And Children ◽

Living With Hiv ◽

Equipment Costs

Background: The number of people living with HIV (PLHIV) in need of treatment monitoring in low-and-middle-income countries is rapidly expanding, straining existing laboratory capacity. Point-of-care viral load (POC VL) testing can alleviate the burden on centralized laboratories and enable faster delivery of results, improving clinical outcomes. However, implementation costs are uncertain and will depend on clinic testing volume. We sought to estimate the costs of decentralized POC VL testing compared to centralized laboratory testing for adults and children receiving HIV care in Kenya. Methods: We conducted microcosting to estimate the per-patient costs of POC VL testing compared to known costs of centralized laboratory testing. We completed time-and-motion observations and stakeholder interviews to assess personnel structures, staff time, equipment costs, and laboratory processes associated with POC VL administration. Capital costs were estimated using a 5 year lifespan and a 3% annual discount rate. Results: We estimated that POC VL testing cost USD $24.25 per test, assuming a clinic is conducting 100 VL tests per month. Test cartridge and laboratory equipment costs accounted for most of the cost (62% and 28%, respectively). Costs varied by number of VL tests conducted at the clinic, ranging from $54.93 to $18.12 per test assuming 20 to 500 VL tests per month, respectively. A VL test processed at a centralized laboratory was estimated to cost USD $25.65. Conclusion: POC VL testing for HIV treatment monitoring can be feasibly implemented in clinics within Kenya and costs declined with higher testing volumes. Our cost estimates are useful to policymakers in planning resource allocation and can inform cost-effectiveness analyses evaluating POC VL testing.

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Managing Pharmacotherapy in People Living With HIV and Concomitant Malignancy

Annals of Pharmacotherapy ◽

10.1177/1060028019833038 ◽

2019 ◽

Vol 53 (8) ◽

pp. 812-832 ◽

Cited By ~ 3

Author(s):

Jacqueline L. Olin ◽

Olga Klibanov ◽

Alexandre Chan ◽

Linda M. Spooner

Keyword(s):

Antiretroviral Therapy ◽

Drug Interactions ◽

Medical Condition ◽

Point Of Care ◽

Multidisciplinary Care ◽

Hiv Care ◽

Chronic Medical Condition ◽

People Living With Hiv ◽

Age Related ◽

Living With Hiv

Objective: To describe data with selected malignancies in people living with HIV (PLWH) and HIV in individuals affected by both conditions and to summarize drug-drug interactions (DDIs) with clinical recommendations for point-of-care review of combination therapies. Data Sources: Literature searches were performed (2005 to December 2018) in MEDLINE and EMBASE to identify studies of malignancies in PLWH in the modern era. Study Selection and Data Extraction: Article bibliographies and drug interaction databases were reviewed. Search terms included HIV, antiretroviral therapy, antineoplastic agents, malignancies, and drug interactions. Data Synthesis: In the pre–antiretroviral therapy (ART) era, malignancies in PLWH were AIDS-defining illnesses, and life expectancy was shorter. Nowadays, PLWH are living longer and developing malignancies, including lung, anal, and prostate cancers. Concurrently, the oncology landscape has evolved, with novel oral targeted agents and immunotherapies becoming routine elements of care. The increased need for and complexity with antineoplastics in PLWH has led to recommendations for multidisciplinary care of this unique population. Evaluation of DDIs requires review of metabolic pathways, absorption mechanisms, and various drug transporters associated with antineoplastics and ART. Relevance to Patient Care and Clinical Practice: This review summarizes available data of non–AIDS-defining malignancies, principles of HIV care in the patient with malignancy, and guidance for assessing DDIs between antineoplastics and ART. Summary DDI tables provide point-of-care recommendations. Conclusions: The availability of ART has transformed AIDS into a chronic medical condition, and PLWH are experiencing age-related malignancies. Pharmacists play an important role in the management of this patient population.

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