A multicenter survey of asymptomatic cryptococcal antigenemia among patients with advanced HIV disease in Nigeria

• Published in: PLOS global public health 2023-01, Vol.3 (1), p.e0001313
• Main Authors: 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
• Format: Article
• Language: English
• ISSN: 2767-3375
• DOI: 10.1371/journal.pgph.0001313

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