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Cryptococcal infection in a cohort of HIV-1-infected Ugandan adults

French, Neil, Gray, K., Watera, C., Nakiyingi, J., Lugada, E., Moore, Michael, Lalloo, David ORCID: https://orcid.org/0000-0001-7680-2200, Whitworth, J. A. G. and Gilks, C.F. (2002) 'Cryptococcal infection in a cohort of HIV-1-infected Ugandan adults'. AIDS, Vol 16, Issue 7, pp. 1031-1038.

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Abstract

Objective: Despite the recognition of Cryptococcus neoformans as a major cause of meningitis in HIV-infected adults in sub-Saharan Africa, little is known about the relative importance of this potentially preventable infection as a cause of mortality and suffering in HIV-infected adults in this region. Design: A cohort study of 1372 HIV-1-infected adults, enrolled and followed up between October 1995 and January 1999 at two community clinics in Entebbe, Uganda. Methods: Systematic and standardized assessment of illness. episodes to describe cryptococcal disease and death rates. Results: Cryptococcal disease was diagnosed in 77 individuals (rate 40.4/1000 person-years) and was associated with 17% of all deaths (77 out of 444) in the cohort. Risk of infection was strongly associated with CD4 T cell counts < 200 x 10(6) cells/l (75 patients) and World Health Organization (WHO) clinical stage 3 and 4 (68 patients). Meningism was present infrequently on presentation (18%). Clinical findings had limited discriminatory diagnostic value. Serum cryptococcal antigen testing was the most sensitive and robust diagnostic test. Cryptococcal antigenaemia preceded symptoms by a median of 22 days (> 100 days in 11 % of patients). Survival following diagnosis was poor (median survival 26 days; range 0-138). Conclusions: Cryptococcal infection is an important contributor to mortality and suffering in HIV-infected Ugandans. Improvements in access to effective therapy of established disease are necessary. In addition, prevention strategies, in particular chemoprophylaxis, should be evaluated while awaiting the outcome of initiatives to make antiretroviral therapy more widely available. (C) 2002 Lippincott Williams Wilkins.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WC Communicable Diseases > Infection. Bacterial Infections > Bacterial Infections > WC 245 Meningococcal infections
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
Faculty: Department: Groups (2002 - 2012) > Clinical Group
Digital Object Identifer (DOI): https://doi.org/10.1097/00002030-200205030-00009
Depositing User: Martin Chapman
Date Deposited: 28 Feb 2013 10:12
Last Modified: 06 Feb 2018 13:05
URI: http://archive.lstmed.ac.uk/id/eprint/2913

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