Prevalence and mortality of cryptococcal disease in adults with advanced HIV in an urban tertiary hospital in Sierra Leone: a prospective study
Prevalence and mortality of cryptococcal disease in adults with advanced HIV in an urban tertiary hospital in Sierra Leone: a prospective study
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DOI：
10.1186/s12879-020-4862-x
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发表时间：
2020-02-14
影响因子：
3.7
通讯作者：
Beynon, Fenella
中科院分区：
文献类型：
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作者：
Lakoh, Sulaiman;Rickman, Hannah;Beynon, Fenella
全球每年与隐球菌病相关的死亡人数估计超过18万，其中四分之三发生在撒哈拉以南非洲。世界卫生组织（WHO）建议对所有CD 4计数< 100/mu l的HIV患者进行隐球菌抗原（CrAg）筛查。由于此前没有关于塞拉利昂隐球菌病的负担和影响的研究，因此需要进行研究以告知公共卫生政策。我们的目的是建立隐球菌病的血清阳性率和死亡率的成年人与先进的艾滋病毒出席城市三级医院在塞拉利昂。方法采用前瞻性队列研究设计，筛查2018年1月至4月期间塞拉利昂弗里敦康诺特医院CD 4计数低于100个细胞/mm（3）的连续成人（18岁或以上）HIV患者。参与者接受血液CrAg侧流测定（IMMY，俄克拉荷马州，美国）。所有血清CrAg阳性的参与者均进行了腰椎穿刺和脑脊液（CSF）CrAg检测，隐球菌病患者接受了氟康唑单药治疗，随访8周。将数据输入Excel，并在Stata版本13.0中进行分析。使用比例、中位数和四分位距总结数据。Fisher精确检验用于比较分类变量。结果共筛选了170例患者，中位年龄为36岁（IQR 30-43），中位CD 4计数为45个细胞/mm 3（IQR 23-63）。在入组时，54%为住院患者，51%为新诊断的HIV感染者，56%为ART初治或新启动（
Background The global annual estimate for cryptococcal disease-related deaths exceeds 180,000, with three fourth occurring in sub-Saharan Africa. The World Health Organization (WHO) recommends cryptococcal antigen (CrAg) screening in all HIV patients with CD4 count < 100/mu l. As there is no previous published study on the burden and impact of cryptococcal disease in Sierra Leone, research is needed to inform public health policies. We aimed to establish the seroprevalence and mortality of cryptococcal disease in adults with advanced HIV attending an urban tertiary hospital in Sierra Leone. Methods A prospective cohort study design was used to screen consecutive adult (18 years or older) HIV patients at Connaught Hospital in Freetown, Sierra Leone with CD4 count below 100 cells/mm(3) from January to April 2018. Participants received a blood CrAg lateral flow assay (IMMY, Oklahoma, USA). All participants with a positive serum CrAg had lumbar puncture and cerebrospinal fluid (CSF) CrAg assay, and those with cryptococcal diseases had fluconazole monotherapy with 8 weeks followed up. Data were entered into Excel and analysed in Stata version 13.0. Proportions, median and interquartile ranges were used to summarise the data. Fisher's exact test was used to compare categorical variables. Results A total of 170 patients, with median age of 36 (IQR 30-43) and median CD4 count of 45 cells/mm(3) (IQR 23-63) were screened. At the time of enrolment, 54% were inpatients, 51% were newly diagnosed with HIV, and 56% were either ART-naive or newly initiated (