Prevalence and management of cryptococcal antigenemia in hospitalized patients with advanced HIV infection in a tertiary hospital from Fortaleza, Ceará, Brazil between 2020 and 2022

In 2020, among adult patients with advanced HIV infection > 150,000 cases of cryptococcal meningitis (CM) were recorded and the prevalence of cryptococcal antigenemia was 4.4% in the world. This study aimed to investigate the presence of cryptococcal antigenemia among hospitalized patients with advanced HIV infection from Northeastern Brazil. This was a retrospective and cross-sectional study in patients hospitalized between 2020 and 2022. Epidemiological, clinical, and laboratory data were obtained by review from medical records. A qualitative CrAg by lateral flow assay was performed in serum samples of HIV patients. During the study period 63 patients were included. Men represented 77.8% of the patients and the median patient age was 38 years. The median CD4+ cell count was 33 cells/µL (IQR 12.5–85.5) and the median log of viral load was 4.95 (IQR 4.21–5.53). Overall prevalence of cryptococcal antigenemia was of 11.1% (7/63), and in patients with a CD4+ cell count of < 100 cells/µL was of 8.5% (4/47). Six patients underwent lumbar puncture collection of cerebrospinal fluid (CSF). CM was confirmed in one patient (16.7%; 1/6). Another patient had disseminated cryptococcal disease. Isolated cryptococcal antigenemia was identified in 7.9% (5/63) of the study population. Two patients dead during hospitalization, and non-evidence of cryptococcal disease was identified. Two asymptomatic patients received fluconazole as pre-emptive therapy, and one patient did not receive antifungal drugs. None of these patients developed CM until 12 months post-discharge. Patients who tested positive for CrAg had a 6-fold higher risk of death than patients who tested negative for CrAg during hospitalization. The prevalence of cryptococcal antigenemia and the risk of death were high among patients with advanced HIV infection from Ceará. Therefore, screening with CrAg should be available to all patients in regions where the burden of cryptococcal disease among people living with HIV is high.