Prevalence of Cryptococcal Antigenemia and associated factors among HIV/AIDS patients on second-line antiretroviral therapy at two hospitals in Western Oromia, Ethiopia

Autoři: Nuguse Geda aff001;  Tafese Beyene aff002;  Regea Dabsu aff001;  Hylemariam Mihiretie Mengist aff003
Působiště autorů: Department of Medical Laboratory Sciences, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia aff001;  Department of Medical Laboratory Sciences, College of Health Sciences, Arsi University, Assela, Ethiopia aff002;  Department of Medical Laboratory Sciences, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia aff003
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
prolekare.web.journal.doi_sk: 10.1371/journal.pone.0225691



Cryptococcosis is a global public health important infectious disease. HIV infection is the main risk factor estimated to account for 95% of cases in the middle- and low-income countries and 80% of the cases in high-income countries.


The main aim of the study was to determine the prevalence and associated risk factors of Cryptococcal antigenemia (CrAg) among HIV/AIDS Patients on second-line ART Therapy at Ambo General Hospital and Nekemte Referral Hospital, Western Oromia, Ethiopia.

Materials and methods

Hospital-based cross-sectional study was employed from September 1, 2017, to October 30, 2017. Whole blood was tested for CrAg using Cryptococcal lateral flow assay (Immuno-Mycologics, Norman, OK, USA) according to the manufacturer's instructions. The collected data were analyzed using SPSS version 20 software. Binary logistic regression models were applied to assess the association between predictors and outcome variables at 95% CI.


Among the study participants, 115(62.8%) were females and the median age of the participants was 35 (IQR: 14) years. Majority, 169(92.3%), have been living with HIV for ≥ 5.6 years and 124 (67.8%) stayed on 2nd line ART for an average of 2.5 years. The overall prevalence of Cryptococcal antigenemia in the study participants was 7.7% (14/183). Being male [AOR, 95% CI: 4.78(1.14, 20.1)], poor adherence to ART [AOR, 95% CI: 0.12(0.03, 0.4)], occupational exposures to contaminated soil [AOR, 95% CI: 6.81(1.38, 33.4)], having non-separated house from chickens [AOR, 95% CI: 0.06(0.01, 0.51)], CD4 T+ cell levels ≤ 100 cell/μL [AOR, 95% CI: 6.57(1.9, 23.3)] and viral load >1000 copies/mL [AOR, 95% CI: 11.7(2.4, 57.8)] were significant predictors of Cryptococcal antigenemia (P≤ 0.05).


The prevalence of Cryptococcal Antigenemia was significantly high in this study. Being male, occupational exposure to contaminated soil with avian droppings, CD4+ T cell levels <100 cell/μL and viral load >1000 copies/mL were significant predictors of Cryptococcal antigenemia. Therefore, public health measures, adherence to ART and early treatment are recommended.

Klíčová slova:

Cryptococcus – Opportunistic infections – T cells – Viral load – Cryptococcosis – Cryptococcal meningitis


1. Perfect JR, Bicanic T. Cryptococcosis diagnosis and treatment: What do we know now? Fungal Genet Biol 78:2015; 49–54. doi: 10.1016/j.fgb.2014.10.003 25312862

2. Hagen F, Khayhan K, Theelen B, Kolecka A, Polacheck I. Recognition of seven species in the Cryptococcus gattii/Cryptococcus neoformans species complex. Fungal Genet Biol 78: 2015; 16–48. doi: 10.1016/j.fgb.2015.02.009 25721988

3. Casadevall A, Perfect JR. Cryptococcus neoformans. ASM Press, Washington, DC, USA; 1998.

4. Leimann BC, Koifman RJ. Cryptococcal meningitis in Rio de Janeiro State, Brazil, 1994–2004. Cad Saude Publica. 2008; 24:2582–2592. doi: 10.1590/s0102-311x2008001100013 19009138

5. Calmy A, Klement E, Teck R, Berman D, Pecoul B, Ferradini L. Simplifying and adapting antiretroviral treatment in resource-poor settings: a necessary step to scaling-up. AIDS. 2004; 18:2353–60. 15622311

6. Jongwutiwes U, Kiertiburanakul S, Sungkanuparph S. Impact of antiretroviral therapy on the relapse of cryptococcosis and survival of HIV-infected patients with cryptococcal infection. Infect Dis.2007; 5:355–60.

7. Longley N, Jarvis JN, Meintjes G, Boulle A, Cross A, Kelly N. Cryptococcal antigen screening in patients initiating ART in South Africa: a prospective cohort study. 2016; 62:581–7.

8. Baldassarre R, Mdodo R, Omonge E, Jaoko W, Baddley J, Pappas P. Mortality after clinical management of AIDS-associated CM. Clin Infect. 2014; 91:145–51.

9. Beyene T, Woldeamanuel Y, Asrat D, Ayana G, Boulware DR. Comparison of Cryptococcal Antigenemia between Antiretroviral Naı ¨ve and Antiretroviral Experienced HIV Positive Patients at Two Hospitals in Ethiopia. PLoS ONE 8(10): 2013; e75585. doi: 10.1371/journal.pone.0075585 24124498

10. Perfect JR, Bicanic T. Cryptococcosis diagnosis and treatment: what do we know now? Fungal Genet Biol. 2014; pi: S1087–1845(14)00186-8.

11. Jarvis JN, Govender N, Chiller T, Park BJ, Longley N, Meintjes G. Cryptococcal antigen screening and preemptive therapy in patients initiating antiretroviral therapy in resource-limited settings: a proposed algorithm for clinical implementation. 2012; 11: 374–379. doi: 10.1177/1545109712459077 23015379

12. Kozel TR, Bauman SK. CrAg Lateral Flow Assay for Cryptococcosis. Fungal Genet Biol.2012; 6: 245–251.

13. Alemu AS, Kempker Russell R., Admasu Tenna, Christopher Smitson, Nega Berhe, Daniel Fekade, Blumberg Henry M., and Abraham Aseffa. High Prevalence of Cryptococcal Antigenemia among HIV-infected Patients Receiving Antiretroviral Therapy in Ethiopia. 2013.

14. Ahmad R. G, Agnes R. I, Rudi W, Hinta M, Andre V, Bachti A, and Reinout C. Asymptomatic cryptococcal antigenemia is associated with mortality among HIV-positive patients in Indonesia. licensee International AIDS Society. 2014 doi: 10.7448/IAS.17.1.18821 24476751

15. Moges NA, Kassa GM. Prevalence of Opportunistic Infections and Associated Factors among HIV Positive Patients taking Anti-Retroviral Therapy in Debre Markos Referral Hospital, Northwest Ethiopia. 2014; 5:301. doi: 10.4172/2155-6113.1000301

16. Sheel P, Gee Yen S, Ishan W, S. V, Ian C, Mark P, Thomas S. H, Tihana B. The prevalence of Cryptococcal antigenemia in newly diagnosed HIV patients in a Southwest London Cohort. Fungal Genet.2013. doi: 10.1016/j.jinf.2012.09.014 23046967

17. Ofonime M. Ogba and Lydia Abia-Bassey. Cryptococcal antigenemia among HIV seropositive patients accessing care in antiretroviral therapy (ART) clinics in Calabar, South Southern Nigeria. Fungal Genet.2017.

18. Jean Louis F, Andre JA, Perrin G, Domercant JW, Francois K. Low Prevalence of Cryptococcal Antigenemia among Patients Infected with HIV/AIDS in Haiti. Fungal Genet.2016; 7:577. doi: 10.4172/2155-6113.1000577

19. Mdodo R., Brown K., Omonge E., Jaoko W., Baddley J., Pappas P., Colette-Kempf M., Aban I., Odera S., Saleh A., and Jolly P. E. Prevalence, Clinical Features, Risk Factors, and Outcome associated with Cryptococcal meningitis in HIV positive patients in Kenya.Clin Infect Dis.2013.

20. Oladele R.O., Akanmu A. S., Nwosu A.O., Ogunsola F. T., Richardson M. D., and Denning D. W. Cryptococcal Antigenemia in Nigerian Patients with Advanced Human Immunodeficiency Virus: Influence of Antiretroviral Therapy Adherence. 2015.

21. Currie B. P., & Casadevall A. Estimation of the prevalence of cryptococcal infection among patients infected with human immunodeficiency virus in New York City. Clin Infect Dis. 2009; 1029–1033.

22. Schuurman R, Descamps D, Weverling GJ, Kaye S, Tijnagel J, William I. Multicenter comparison of three commercial methods for quantification of human immunodeficiency virus type 1 RNA in plasma. Fungal Genet Biol.1996; 34:3016–22.

23. Kingese P. R., Hawkins A. T., Maro V. P., et al. Low CD4 count plus coma predict cryptococcal meningitis in Tanzania. BMC Infect Dis, 2007; 39

24. French N., Gray K., Watera C., Nakayingi J., Lugada E., & Moore M. Cryptococcal infection in a cohort of HIV-1-infected Ugandan adults. Med J. AIDS, 2005; 1031–1038.

25. Micol R., Lortholary O., Sar B., et al. Prevalence determinants of positivity and clinical utility of cryptococcal antigenemia in Cambodian HIV-infected patients. J Acquir Immune DeficSyndr, 2007; 555–559.

26. Jarvis J. N., Lawn S. D., Vogt M., Bangani N., Wood R., & Harrison T. S. Screening cryptococcal antigenemia in patients accessing an antiretroviral treatment program in South Africa. Clin Infect Dis, 2009; 856–862. doi: 10.1086/597262 19222372

27. Mdodo R., Brown K., Omonge E., Jaoko W., Baddley J., Pappas P., Colette-Kempf M., Aban I., Odera S., Suleh A., and Jolly P. E. Prevalence, Clinical Features, Risk Factors, and Outcome associated with Cryptococcal meningitis in HIV positive patients in Kenya. Clin Infect Dis.2013.

Článok vyšiel v časopise


2019 Číslo 12