A multicenter survey of asymptomatic cryptococcal antigenemia among patients with advanced HIV disease in Nigeria
As of 2018, cryptococcal antigen (CrAg) screening in patients with advanced human immunodeficiency virus (HIV) disease (AHD) was not routinely implemented in Nigeria despite being recommended in the national HIV treatment guidelines. Our aim was to determine the prevalence and risk factors for asymp...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2023-01-01
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| Series: | PLOS Global Public Health |
| Online Access: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021610/?tool=EBI |
| _version_ | 1797700023339712512 |
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| author | Rita O. Oladele Alexander M. Jordan Joy U. Okaa Iriagbonse I. Osaigbovo Shuwaram A. Shettima Nathan Y. Shehu Adeyinka A. Davies Yahaya Mohammed Mary A. Alex-Wele Garba Iliyasu Jude C. Nwaokenye Samuel A. Fayemiwo Ubong A. Udoh Titilola Gbajabiamila David W. Denning Tom M. Chiller |
| author_facet | Rita O. Oladele Alexander M. Jordan Joy U. Okaa Iriagbonse I. Osaigbovo Shuwaram A. Shettima Nathan Y. Shehu Adeyinka A. Davies Yahaya Mohammed Mary A. Alex-Wele Garba Iliyasu Jude C. Nwaokenye Samuel A. Fayemiwo Ubong A. Udoh Titilola Gbajabiamila David W. Denning Tom M. Chiller |
| author_sort | Rita O. Oladele |
| collection | DOAJ |
| description | As of 2018, cryptococcal antigen (CrAg) screening in patients with advanced human immunodeficiency virus (HIV) disease (AHD) was not routinely implemented in Nigeria despite being recommended in the national HIV treatment guidelines. Our aim was to determine the prevalence and risk factors for asymptomatic cryptococcal antigenemia in adult people living with HIV (PLHIV) in Nigeria to advocate for the implementation of routine CrAg screening. A descriptive cross-sectional study and CrAg screening of consecutive adult PLHIV with CD4 counts ≤200 cells/μL was conducted from April 2018 to April 2019 at HIV clinics in eleven tertiary hospitals spread across Nigeria’s six geopolitical regions. Prevalence of asymptomatic cryptococcal antigenemia was estimated by facility and geopolitical zone. Logistic regression was conducted to identify risk factors for cryptococcal antigenemia. In total, 1,114 patients with AHD were screened. The overall prevalence of asymptomatic cryptococcal antigenemia was 3.9% with wide variation across facilities (range: 0/75 [0%]– 15/122 [12.3%]) and geopolitical zones (range: 0/75 [0%]–19/279 [6.8%]). Prevalence of antigenemia was highest in the South-West (19/279 [6.8%]) and lowest in the North-East (0/75 [0%]). Prevalence was 5.2% (26/512) and 3.2% (18/561) in patients with CD4<100 and CD4 of 101–200, respectively. Of all patients with antigenemia, 50% were on antiretroviral therapy (ART) at the time of having a positive CrAg test. In adjusted analysis, cryptococcal antigenemia was significantly less in patients on ART and patients who had completed any formal education. The survey showed a high overall burden of cryptococcal antigenemia in Nigeria, with variable prevalence across geopolitical regions. We provided valuable evidence for implementing routine CrAg screening of AHD patients in Nigeria which has commenced in selected centres. |
| first_indexed | 2024-03-12T04:16:09Z |
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| institution | Directory Open Access Journal |
| issn | 2767-3375 |
| language | English |
| last_indexed | 2024-03-12T04:16:09Z |
| publishDate | 2023-01-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLOS Global Public Health |
| spelling | doaj.art-810f15ebfccf417084a482a4ac79ab1f2023-09-03T10:36:07ZengPublic Library of Science (PLoS)PLOS Global Public Health2767-33752023-01-0131A multicenter survey of asymptomatic cryptococcal antigenemia among patients with advanced HIV disease in NigeriaRita O. OladeleAlexander M. JordanJoy U. OkaaIriagbonse I. OsaigbovoShuwaram A. ShettimaNathan Y. ShehuAdeyinka A. DaviesYahaya MohammedMary A. Alex-WeleGarba IliyasuJude C. NwaokenyeSamuel A. FayemiwoUbong A. UdohTitilola GbajabiamilaDavid W. DenningTom M. ChillerAs of 2018, cryptococcal antigen (CrAg) screening in patients with advanced human immunodeficiency virus (HIV) disease (AHD) was not routinely implemented in Nigeria despite being recommended in the national HIV treatment guidelines. Our aim was to determine the prevalence and risk factors for asymptomatic cryptococcal antigenemia in adult people living with HIV (PLHIV) in Nigeria to advocate for the implementation of routine CrAg screening. A descriptive cross-sectional study and CrAg screening of consecutive adult PLHIV with CD4 counts ≤200 cells/μL was conducted from April 2018 to April 2019 at HIV clinics in eleven tertiary hospitals spread across Nigeria’s six geopolitical regions. Prevalence of asymptomatic cryptococcal antigenemia was estimated by facility and geopolitical zone. Logistic regression was conducted to identify risk factors for cryptococcal antigenemia. In total, 1,114 patients with AHD were screened. The overall prevalence of asymptomatic cryptococcal antigenemia was 3.9% with wide variation across facilities (range: 0/75 [0%]– 15/122 [12.3%]) and geopolitical zones (range: 0/75 [0%]–19/279 [6.8%]). Prevalence of antigenemia was highest in the South-West (19/279 [6.8%]) and lowest in the North-East (0/75 [0%]). Prevalence was 5.2% (26/512) and 3.2% (18/561) in patients with CD4<100 and CD4 of 101–200, respectively. Of all patients with antigenemia, 50% were on antiretroviral therapy (ART) at the time of having a positive CrAg test. In adjusted analysis, cryptococcal antigenemia was significantly less in patients on ART and patients who had completed any formal education. The survey showed a high overall burden of cryptococcal antigenemia in Nigeria, with variable prevalence across geopolitical regions. We provided valuable evidence for implementing routine CrAg screening of AHD patients in Nigeria which has commenced in selected centres.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021610/?tool=EBI |
| spellingShingle | Rita O. Oladele Alexander M. Jordan Joy U. Okaa Iriagbonse I. Osaigbovo Shuwaram A. Shettima Nathan Y. Shehu Adeyinka A. Davies Yahaya Mohammed Mary A. Alex-Wele Garba Iliyasu Jude C. Nwaokenye Samuel A. Fayemiwo Ubong A. Udoh Titilola Gbajabiamila David W. Denning Tom M. Chiller A multicenter survey of asymptomatic cryptococcal antigenemia among patients with advanced HIV disease in Nigeria PLOS Global Public Health |
| title | A multicenter survey of asymptomatic cryptococcal antigenemia among patients with advanced HIV disease in Nigeria |
| title_full | A multicenter survey of asymptomatic cryptococcal antigenemia among patients with advanced HIV disease in Nigeria |
| title_fullStr | A multicenter survey of asymptomatic cryptococcal antigenemia among patients with advanced HIV disease in Nigeria |
| title_full_unstemmed | A multicenter survey of asymptomatic cryptococcal antigenemia among patients with advanced HIV disease in Nigeria |
| title_short | A multicenter survey of asymptomatic cryptococcal antigenemia among patients with advanced HIV disease in Nigeria |
| title_sort | multicenter survey of asymptomatic cryptococcal antigenemia among patients with advanced hiv disease in nigeria |
| url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021610/?tool=EBI |
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