Screening of cryptococcal antigen among HIV-positive patients with low CD4 count in a tertiary care Centre

Context: Cryptococcal meningitis is an opportunistic fungal infection which is seen among people with compromised cell-mediated immunity. It is an important cause of morbidity and mortality among HIV-positive patients. Most cases occur in advanced HIV disease (CD4 cell count <200 cells/mm 3 ). The risk increases with a progressive decrease in CD4 cell count. Aim: It is important to diagnose early by screening for serum cryptococcal antigen and start treatment, thereby preventing patients from developing cryptococcal meningitis. Methods and Materials: It is a retrospective study. Data were collected from the case records for the period August 2019 to July 2021. The study population is HIV-positive patients attending the outpatient department of medicine with a CD4 count of less than 200. The study group included both antiretroviral treatment (ART) naïve and patients who were already on ART. Statistical Analysis Used: Statistical analysis was done using SPSS version 26. The prevalence was represented in percentages. Chi-square test/Fisher’s exact test was used to calculate the association between various socio-demographic variables and HIV parameters. Spearman correlation was done to assess the strength and magnitude of associations. Results: Among the study participants, 9.6% ( n = 16) were serum cryptococcal antigen positive. In this study, among HIV-positive patients who were serum cryptococcal antigen positive, 75% ( n = 12) had CD4 count less than 100 and 25% ( n = 4) had a CD4 count between 101 and 200. All the patients were asymptomatic for cryptococcal meningitis. Nobody developed cryptococcal meningitis after initiation of ART. Conclusion: It is advised to screen for the presence of serum cryptococcal antigen in all HIV-positive patients with CD4 count less than 200, though it is more common among patients with CD4 count less than 100.