Screening for Cryptococcal Antigenemia and Burden of Cryptococcosis at the Time of HIV Diagnosis: A Retrospective Multicenter Study

doi:10.1007/s40121-021-00451-5

中山醫學大學機構典藏 CSMUIR > 中山醫學大學研究成果 > 期刊論文 > Item 310902500/23464

Please use this identifier to cite or link to this item: https://ir.csmu.edu.tw:8080/ir/handle/310902500/23464

Title:	Screening for Cryptococcal Antigenemia and Burden of Cryptococcosis at the Time of HIV Diagnosis: A Retrospective Multicenter Study
Authors:	Huang, SH;Lee, CY;Tsai, CS;Tsai, MS;Liu, CE;Hsu, WT;Chen, HA;Liu, WD;Yang, CJ;Sun, HY;Ko, WC;Lu, PL;Lee, YT;Hung, CC
Keywords:	Opportunistic infections;Cryptococcal antigen;Cryptococcal meningitis;People living with HIV;Late presenter;Care cascade
Date:	2021
Issue Date:	2022-08-05T09:37:44Z (UTC)
Publisher:	SPRINGER LONDON LTD
ISSN:	2193-8229
Abstract:	Introduction Screening for cryptococcal antigen (CrAg) is recommended for people living with HIV (PLWH) who present with low CD4 lymphocyte counts. Real-world experience is important to identify gaps between the guidelines and clinical practice. We investigated the trends of CrAg testing and prevalence of cryptococcal antigenemia among PLWH at the time of HIV diagnosis and the related mortality in Taiwan from 2009 to 2018. Methods Medical records of newly diagnosed PLWH seeking care at six medical centers around Taiwan between 2009 and 2018 were reviewed. The annual trends of PLWH who had CrAg testing and cryptococcal antigenemia were examined by Cochran-Armitage test. Among PLWH with CD4 < 200 cells/mu l, timing of CrAg testing was analyzed for association with 12-month all-cause mortality in Kaplan-Meier plots and in a Cox proportional hazards model after adjustments. Results Among 5372 included PLWH, 1150 (21.4%) presented with baseline CD4 < 100 cells/mu l, and this proportion had decreased during the study period [from 108 (29.3%) in 2009 to 93 (22.3%) in 2018 (P = 0.039)]. The overall prevalence of cryptococcal antigenemia was 7.8% among PLWH with CD4 < 100 cells/mu l, which remained stable during the 10-year study period (P = 0.356) and was 2.6% among PLWH with CD4 100-199 cells/mu l. The uptake of CrAg testing had increased from 65.7% in 2009 to 78.0% in 2018 (P = 0.002) among PLWH with CD4 < 100 cells/mu l. Late CrAg testing, defined by 14 days or later after HIV diagnosis, was associated with increased risk of 12-month mortality compared to early CrAg testing (adjusted hazard ratio 2.028, 95% CI 1.109-3.708). Conclusions Burden of cryptococcosis remained high among PLWH with low CD4 lymphocyte counts in Taiwan. Uptake of CrAg screening among late HIV presenters was still suboptimal and delayed. Late CrAg testing was associated with a higher mortality.
URI:	http://dx.doi.org/10.1007/s40121-021-00451-5 https://www.webofscience.com/wos/woscc/full-record/WOS:000656513900001 https://ir.csmu.edu.tw:8080/handle/310902500/23464
Relation:	INFECTIOUS DISEASES AND THERAPY ,2021,v10,issue 3, P1363-1377
Appears in Collections:	[中山醫學大學研究成果] 期刊論文

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