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 González-Doménech, Carmen María
A1 Pérez-Jacoiste Asín, M.A.
A1 Bisbal, O.
A1 Iribarren, J.A.
A1 Pérez-Rivilla, A.
A1 Mican, R.
A1 Dronda, F.
A1 Vinuesa-García, D.
A1 Macías, J.
A1 Lumbreras, C.
A1 Moreno, S.
A1 Rubio, R.
A1 Members of the Cohorte de la Red de Investigación en Sida (CoRIS), 
K1 Infecciones por VIH
K1 Pulmones - Enfermedades
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
YR 2020
FD 2020-10-16
LK https://hdl.handle.net/10630/29140
UL https://hdl.handle.net/10630/29140
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. doi: 10.1016/j.cmi.2020.09.053.
NO We want to particularly acknowledge the patients in this study for their participation and to the HIV BioBank integrated in the Spanish AIDS Research Network and collaborating Centres for the generous gifts of clinical samples used in this work. The HIV BioBank, integrated in the Spanish AIDS Research Network, is supported by Instituto de Salud Carlos III, Spanish Health Ministry (Grant nº RD06/0006/0035, RD12/0017/0037 and RD16/0025/0019) and Fundación para la Investigación y Prevención del SIDA en España (FIPSE). This study would not have been possible without the collaboration of all patients, medical and nursery staff and data managers who have taken part in the project. The RIS Cohort (CoRIS) is funded by the Instituto de Salud Carlos III through the Red Temática de Investigación Cooperativa en SIDA (RIS C03/173, RD12/0017/0018 and RD16/0002/0006) as part of the Plan Nacional R + D + I and cofinanced by ISCIII-Subdirección General de Evaluación y el Fondo Europeo de Desarrollo Regional (FEDER). The costs of the sample-processing and the microbiological diagnostic tests used for this work have been afforded with the award “Gilead Grants for Biomedical Investigation 6th edition”, Gilead Sciences, Inc. (GLD18/00087). The authors thank Santiago Rojo Robles, laboratory technician, for processing samples and performing microbiological tests. We also thank Dr. Lora-Tamayo and Dr. López-Medrano for their critical read of the manuscript.
DS RIUMA. Repositorio Institucional de la Universidad de Málaga
RD 21 ene 2026