The prevalence of cryptococcal antigenemia in newly diagnosed HIV patients in a Southwest London cohort☆

OBJECTIVES To determine the prevalence of cryptococcal antigenemia in a UK HIV cohort and compare baseline characteristics of patients with and without cryptococcal antigenemia. METHODS Stored sera were retrospectively tested for cryptococcal antigen (CRAG) among newly diagnosed HIV-infected persons with CD4 < 100 cells/μL, who presented to Croydon University and St George's Hospitals, London, between January 2004 and October 2010. We assessed risk factors for cryptococcal antigenemia and patient outcomes by extracting demographic and clinical information from medical records. RESULTS 157 patients were identified with a median age of 47 and CD4 count of 26 cells/μL. 102 (65%) were of Black race and 91 (58%) of African origin. Eight patients (5%) had positive serum CRAG. 7/8 had cryptococcal meningitis (CM) as first presentation of HIV, and 1 had sub-clinical infection. 7/8 (88%) CRAG positives were of African origin compared to 84/149 (54%) of CRAG negatives (p = 0.14). Other baseline characteristics did not differ significantly. CONCLUSION We found a 5% prevalence of cryptococcal antigenemia in newly diagnosed HIV patients with CD4 < 100 cells/μL in southwest London, the first such data for a UK HIV cohort. Cryptococcal antigenemia occurred almost exclusively in African-born individuals. We recommend a UK CRAG screening strategy targeting newly diagnosed African HIV-infected patients with CD4 < 100 cells/μL.