Patients hospitalized with HIV and low CD4 counts should receive routine cryptococcal antigen testing, according to recent data presented at ECCMID 2015.
Researchers reviewed the medical records of 5,461 adult patients with HIV hospitalized in the infectious diseases department of the Vivantes Auguste-Viktoria Klinikum in Berlin from March 2005 through February 2014. Results of serum cryptococcal antigen (CRAG) testing were compared among patients with varying CD4 cell counts and the presence of pneumocystis pneumonia.
They found that cryptococcal antigenemia was present among 1.6% of patients with CD4 counts of no more than 100 cells/µL and 1.1% of patients with CD4 counts between 101 cells/µL and 200 cells/µL. Predictive values for correctly identifying clinically relevant cryptococcal disease among these groups was 96% and 100%, respectively. Median time to diagnosis was shorter among patients admitted directly to the infectious disease department with routine CRAG testing (1 day vs. 7 days; P = .003). Additionally, the prevalence of cryptococcal antigenemia among patients with pneumocystis pneumonia was 2.8%.
“Our data support routine CRAG testing in hospitalized HIV-infected patients with CD4 counts less than or equal to 200/µL, and/or pneumocystis pneumonia,” the researchers wrote.
Katchanov J, et al. Abstract P0526. Presented at: European Congress of Clinical Microbiology and Infectious Diseases; April 25-28, 2015; Copenhagen, Denmark.
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