Date of Award

6-2019

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Mohamed Hanee

Second Supervisor/Advisor

Philip Adebayo

Third Supervisor/Advisor

Ibrahim Sendagire

Department

Internal Medicine (East Africa)

Abstract

Introduction: Cryptococcal meningitis (CM) is a highly fatal disease and contributes to about 20% of all-cause mortality in HIV/AIDS. Sub-Saharan Africa is facing substantial challenges in the treatment of the disease; the focus has been shifted towards prevention of the condition in ART-naive patients with CD4 counts of less than 100 cells/μL. Most studies and interventions have been conducted on ART-naive HIV patients despite there being cases and deaths due to cryptococcal meningitis among ART-experienced patients. Recent studies have shown that although there is an increase in ART coverage among HIV patients, this has not affected the incidence of cryptococcal meningitis.

Objectives: This study aimed at estimating the prevalence of asymptomatic cryptococcal antigenemia in HIV patients in three HIV clinics in Dar es salaam, Tanzania and to compare the proportion of Cryptococcal antigen (CrAg) positivity between ART-naive and ART-experienced patients, determining factors associated with cryptococcal antigenemia and observation of three months outcomes of patients with cryptococcal antigenemia under recommended treatment.

Methods: This was cross sectional study of HIV positive (ART-naïve and ART-experienced) clients attending three care and treatment clinics in Dar es Salaam from September 2018 to February 2019. Individuals with CD4 count ≤200 cells/μL or viral load ≥1000 copies/ml were screened for serum CrAg. Predetermined three months outcomes; development of meningitis, hospitalization and mortality were assessed between groups.

Results: Two seventy three (273) participants with a mean age of 40.4 years in three HIV clinics in Dar es Salaam were enrolled in this study. The overall prevalence of asymptomatic cryptococcal antigenemia (ACA) was 4.8% (13/273; 95% CI: 2.6 – 8.0). The prevalence in the ART- experienced group was lower 2.5% (4/162; 95% CI: 0.7 – 6.2) compared to 8.1% (9/111; 95% CI: 3.8 – 14.8) in ART-naïve patients (p<0.05). Having a history of headache in the past two weeks and hospitalization in the past 12 months were associated with CrAg positivity. Likelihood of death or development of meningitis or hospitalization was higher in CrAg positive patients 69% (p<0.05) compared to CrAg negative patients at 12 weeks.

Conclusion: The overall prevalence of asymptomatic cryptococcal antigenemia in ART-naïve and ART- experienced patients is 4.8% in three HIV clinics in Dar es salaam. Prevalence of asymptomatic cryptococcal antigenemia is lower in ART-experienced patients compared to new cases. CrAg positivity is a good predictor of bad outcome at three months

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