Seroprevalence of cryptoccocal antigenemia in HIV positive adult inpatients with severe immunosuppresion attending the Kenyatta National and Mbagathi Hospitals

Abstract

Background In the world and especially Sub Saharan Africa (SSA), HIV is a leading public health concern. Cryptococcal meningitis (C.M) is the 2nd leading opportunistic infection and is an AIDS defining illness associated with high morbidity and mortality despite the use of HAART and effective anti-fungal treatment. Screening for cryptococcal antigenemia with the use of pre-emptive antifungal therapy may reduce the burden of disease in populations with a high prevalence of cryptococcal antigenemia. The prevalence of cryptococcal antigenemia in Nairobi Kenya has not been established. Objectives To determine the prevalence of cryptococcal antigenemia and associated factors in HIV-infected adult in-patients HAART naïve with low CD4 counts, at the KNH and Mbagathi hospitals. Study design and settings Cross sectional descriptive study that was carried out at Kenyatta National and Mbagathi hospitals’ in-patient medical wards. Methods A total of 196 HIV ELISA positive adult patients HAARTnaïve, with a CD4 of ≤100 cells/μl admitted to the medical wards were consecutively recruited. Their demographic data was captured using a pretested structured questionnaire and were clinically evaluated for WHO clinical staging and symptoms or signs of meningitis. All participants had a serum CRAG assessment and CD4 count done using lateral flow assay, an ELISA method and CyFlow respectively. Prevalence of CRAG serum positivity was ascertained. Association of seropositivity to the demographic, laboratory and clinical characteristics was determined using Chisquare and Student’s T-test. P Value of less than 0.05 was considered significant. Results The seroprevalence of cryptococcal antigenemia was 13.8%. On bivariate analysis cryptococcal antigenemia was associated with neck stiffness. OR 3.9 (1.4-10.7, 95% CI) Seropositivity was not related to other demographic and clinical factors. Conclusion The seroprevalence of cryptococcal antigenemia is high in this population.