Implementation of a rapid diagnostic assay package for cryptococcosis, histoplasmosis and tuberculosis in people living with HIV in Paraguay
Abstract 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 +...
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| Format: | Article |
| Language: | English |
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BMC
2024-04-01
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| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12879-024-09257-5 |
| _version_ | 1827277270964764672 |
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| author | Gloria Aguilar Gladys Lopez Omar Sued Narda Medina Diego H. Caceres Jose Pereira Alexander Jordan Virgilio Lezcano Cristina Vicenti Gustavo Benitez Tania Samudio Freddy Perez |
| author_facet | Gloria Aguilar Gladys Lopez Omar Sued Narda Medina Diego H. Caceres Jose Pereira Alexander Jordan Virgilio Lezcano Cristina Vicenti Gustavo Benitez Tania Samudio Freddy Perez |
| author_sort | Gloria Aguilar |
| collection | DOAJ |
| description | Abstract 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/mm3). 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. |
| first_indexed | 2024-04-24T07:18:07Z |
| format | Article |
| id | doaj.art-0c5f0587d58346fe88fb398053f1acee |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-04-24T07:18:07Z |
| publishDate | 2024-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-0c5f0587d58346fe88fb398053f1acee2024-04-21T11:10:16ZengBMCBMC Infectious Diseases1471-23342024-04-012411910.1186/s12879-024-09257-5Implementation of a rapid diagnostic assay package for cryptococcosis, histoplasmosis and tuberculosis in people living with HIV in ParaguayGloria Aguilar0Gladys Lopez1Omar Sued2Narda Medina3Diego H. Caceres4Jose Pereira5Alexander Jordan6Virgilio Lezcano7Cristina Vicenti8Gustavo Benitez9Tania Samudio10Freddy Perez11National HIV ProgramNational HIV ProgramCommunicable Diseases Prevention, Control, and Elimination and Environmental Determinants of Health Department, Pan American Health OrganizationMycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases (DFWED), ASRT, Inc., Centers for Disease Control and PreventionIMMY, Inc.Centro de Especialidades Dermatológicas, Ministerio de Salud Pública y Bienestar SocialMycotic Diseases Branch-Centers for Disease Control and Prevention (CDC)Instituto de Medicina TropicalInstituto de Medicina TropicalInstituto de Medicina TropicalNational HIV ProgramCommunicable Diseases Prevention, Control, and Elimination and Environmental Determinants of Health Department, Pan American Health OrganizationAbstract 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/mm3). 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.https://doi.org/10.1186/s12879-024-09257-5Opportunistic infections HIVDiagnosticParaguay |
| spellingShingle | Gloria Aguilar Gladys Lopez Omar Sued Narda Medina Diego H. Caceres Jose Pereira Alexander Jordan Virgilio Lezcano Cristina Vicenti Gustavo Benitez Tania Samudio Freddy Perez Implementation of a rapid diagnostic assay package for cryptococcosis, histoplasmosis and tuberculosis in people living with HIV in Paraguay BMC Infectious Diseases Opportunistic infections HIV Diagnostic Paraguay |
| title | Implementation of a rapid diagnostic assay package for cryptococcosis, histoplasmosis and tuberculosis in people living with HIV in Paraguay |
| title_full | Implementation of a rapid diagnostic assay package for cryptococcosis, histoplasmosis and tuberculosis in people living with HIV in Paraguay |
| title_fullStr | Implementation of a rapid diagnostic assay package for cryptococcosis, histoplasmosis and tuberculosis in people living with HIV in Paraguay |
| title_full_unstemmed | Implementation of a rapid diagnostic assay package for cryptococcosis, histoplasmosis and tuberculosis in people living with HIV in Paraguay |
| title_short | Implementation of a rapid diagnostic assay package for cryptococcosis, histoplasmosis and tuberculosis in people living with HIV in Paraguay |
| title_sort | implementation of a rapid diagnostic assay package for cryptococcosis histoplasmosis and tuberculosis in people living with hiv in paraguay |
| topic | Opportunistic infections HIV Diagnostic Paraguay |
| url | https://doi.org/10.1186/s12879-024-09257-5 |
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