RT Journal Article
T1 Cryptococcal infection in HIV-infected patients with CD4 T-cell counts under 100/μL diagnosed in a high-income country: a multicentre cohort study
A1 Pérez-Jacoiste Asín, María Asunción
A1 Bisbal, Otilia
A1 Iribarren, José Antonio
A1 Pérez Rivilla, José Alfredo
A1 Mican, Rafael
A1 Dronda, Fernando
A1 González Domenech, Carmen María
A1 Vinuesa García, David
A1 Macías, Juan
A1 Lumbreras Bermejo, Carlos Juan
A1 Moreno, Santiago
A1 Rubio García, Rafael
AB Objectives: The World Health Organization recommends routinely screening HIV-infected patients with CD4+ T-cell counts <100/μL for cryptococcal infection to prevent cryptococcal meningitis (CM), based on studies in Sub-Saharan Africa where the prevalence of positive cryptococcal antigen (CrAg+) is ≥ 3% in this subgroup. Data about such prevalence in Spain are unavailable and rare in other European countries. Thus, the Spanish AIDS Study Group guidelines do not recommend routinely screening. We aim to determine the prevalence and outcomes of cryptococcal infection in this subgroup of patients in Spain.Methods: We determined CrAg using a lateral flow assay in banked plasma from participants in the cohort of the Spanish AIDS Research Network. Eligible patients had CD4+ T-cell counts ≤100/μL at the time of plasma collection and a follow-up >4 weeks, unless they died.Results: We included 576 patients from June 2004 to December 2017. Of these, 43 were CrAg+ for an overall prevalence of 7.5%. There were no differences depending on birthplace. The CrAg+ was independently associated with a higher mortality at eight weeks (hazard ratio (HR) 5.36, 95% confidence interval (CI) 1.46-19.56) and 6 months (HR 3.12, 95% CI 1.19-8.21). CM was reported in 10 of the 43 CrAg+ patients. There were no cases among negatives. Five patients had CM when the plasma was collected and five developed it during the follow-up. The number of subjects needed to screen to anticipate the diagnosis of one CM case was 114.Conclusions: The CrAg+ prevalence among HIV-infected patients with CD4+ T-cell counts ≤100/μL diagnosed in Spain, both immigrants and native-born Spanish, is >7%. Consequently, the Spanish AIDS Study Group guidelines have to be updated and recommend routine screening for cryptococcal infection in these patients. Future studies should explore whether this recommendation could be firmly applied to other European populations.
PB Elsevier
SN 1198-743X
YR 2021
FD 2021
LK https://hdl.handle.net/20.500.14352/105596
UL https://hdl.handle.net/20.500.14352/105596
LA eng
NO Pérez-Jacoiste Asín MA, Bisbal O, Iribarren JA, Pérez-Rivilla A, Mican R, Dronda F, González-Domenech CM, Vinuesa-García D, Macías J, Lumbreras C, Moreno S, Rubio R; members of the Cohorte de la Red de Investigación en Sida (CoRIS). Cryptococcal infection in HIV-infected patients with CD4 T-cell counts under 100/μL diagnosed in a high-income country: a multicentre cohort study. Clin Microbiol Infect. 2021 Aug;27(8):1171.e1-1171.e7
NO Fondos FEDER
NO European Commission
NO Ministerio de Sanidad (España)
NO Instituto de Salud Carlos III (España)
NO Fundación para la Investigación y Prevención del Sida en España
DS Docta Complutense
RD 24 ene 2026