Cryptococcus neoformans Antigenemia in HIV Positive Pregnant Women Attending a PMTCT Clinic in South-East Nigeria

Abstract

Cryptoccocus neoformans infection is life threatening especially when associated with HIV disease. Unfortunately, in our environment, scant attention has been paid to screening for this fungal disease despite reports of relatively high co-infection rates with HIV in other countries facing similar HIV/AIDS burden. Among people living with HIV/AIDS, there is a significant population of pregnant women. In pregnancy itself, there is immunosuppression, thus combining with the immunosuppression seen in HIV disease. This study was therefore designed to determine the prevalence of cryptoccocus neoformans infection, among HIV seropositive pregnant women attending a prevention of mother to child transmission (PMTCT) of HIV treatment centre. Two hundred and eighty (280) women were recruited for the study. One hundred and sixty (160) of the subjects were HIV seropositive (test group) while 120 HIV seronegative pregnant women served as controls. The test group was sub-divided into three groups based on their CD4 counts: <200, 200-300 and >300 cells??l. Blood was collected by venipuncture and HIV status was determined by current national serial algorithm using Determine and Stat Pak test kits. The test for Cryptoccocus neoformans was performed using latex cryptococcal antigen (CRAG) detection kits.CD4 counts was determined using the Partec cyflow analyzer.  A prevalence rate of 13.1% was observed among HIV seropositive subjects, while none (0%) of the control group tested positive. Cryptococcal antigenemia correlated with decreasing CD4 counts with most of the positive subjects having CD4 counts below 200 cells/?l. It is recommended that targeted cryptococcal screening be made a part of baseline tests in HIV positive pregnant women with low CD4 + T cell counts. This will reduce preventable deaths and improve obstetric outcome in this vulnerable group.

Keywords: Cryptoccocus neoformans, HIV/AIDS, Pregnancy