Article

Cryptococcal infection in a cohort of HIV-1-infected Ugandan adults

Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK.
AIDS (Impact Factor: 6.56). 05/2002; 16(7):1031-8. DOI: 10.1097/00002030-200205030-00009
Source: PubMed

ABSTRACT Despite the recognition of Cryptococcus neoformans as a major cause of meningitis in HIV-infected adults in sub-Saharan Africa, little is known about the relative importance of this potentially preventable infection as a cause of mortality and suffering in HIV-infected adults in this region.
A cohort study of 1372 HIV-1-infected adults, enrolled and followed up between October 1995 and January 1999 at two community clinics in Entebbe, Uganda.
Systematic and standardized assessment of illness episodes to describe cryptococcal disease and death rates.
Cryptococcal disease was diagnosed in 77 individuals (rate 40.4/1000 person-years) and was associated with 17% of all deaths (77 out of 444) in the cohort. Risk of infection was strongly associated with CD4 T cell counts < 200 x 10(6) cells/l(75 patients) and World Health Organization (WHO) clinical stage 3 and 4 (68 patients). Meningism was present infrequently on presentation (18%). Clinical findings had limited discriminatory diagnostic value. Serum cryptococcal antigen testing was the most sensitive and robust diagnostic test. Cryptococcal antigenaemia preceded symptoms by a median of 22 days (> 100 days in 11% of patients). Survival following diagnosis was poor (median survival 26 days; range 0-138).
Cryptococcal infection is an important contributor to mortality and suffering in HIV-infected Ugandans. Improvements in access to effective therapy of established disease are necessary. In addition, prevention strategies, in particular chemoprophylaxis, should be evaluated while awaiting the outcome of initiatives to make antiretroviral therapy more widely available.

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Available from: Jessica Nakiyingi-Miiro, Aug 10, 2015
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    • "In sub-Saharan Africa and South-East Asia, invasive cryptococcal disease is the second most common life-threatening HIV-associated opportunistic infection after tuberculosis and results in up to 20% of deaths (Tansuphasawadikul et al. 1999; Chariyalertsak et al. 2001; French et al. 2002; Lawn et al. 2008). A recent study estimates that cryptococcal meningitis may even be surpassing tuberculosis as the leading cause of death among individuals with HIV infection in sub-Saharan Africa (Park et al. 2009). "
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    Tropical Medicine & International Health 02/2013; 18(4). DOI:10.1111/tmi.12067 · 2.30 Impact Factor
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    • "Country Population CRAG + outcomes Comments French 2002 Uganda 1372 HIV+, No ART Average survival 26 days Serum CRAG was a sensitive test. Detectable a median of 22 days before symptoms (100 days in 11%). "
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    JAIDS Journal of Acquired Immune Deficiency Syndromes 04/2012; 59(5):e85-91. DOI:10.1097/QAI.0b013e31824c837e · 4.39 Impact Factor
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    • "Current trends indicate that, most cases of cyptococcal meningitis found in Africa are among HIV-infected people with <100 cells/µl CD4 T cell count. Based on reported figures it is known that cyptococcal meningitis causes between 10-20 % deaths in Africa (French, 2002; Okongo, 1998; Park, 2009). Recently, a study in Malawi found cyptococcal meningitis to be the most common cause of meningitis disease with 40 % of cases from HIV-infected people. "
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