Prevalence of Cryptoccocal Meningitis in Advanced HIV Disease at Kitale County Hospital, Kenya
Violet Wanyonyi1** Hamisi Noah1, Alex Isagi1, JamesMairura1, Seth Shikuku2.
1Academic Model Providing Access to Health (AMPATH), P.O. Box 4606-30100, Eldoret Kenya
2Kitale County Hospital, P.O. Box 98- 30200, Trans Nzoia Kenya
Background
Cryptococcal disease is one of the opportunistic infections among People living with HIV at an advanced stage and is a major contributor to HIV related morbidity and mortalities. This study was designed to assess prevalence of Cryptococcal Meningitis in advanced HIV Disease at Kitale County referral hospital in Trans Nzoia County-Kenya.
Objectives
1. To determine the prevalence of Cryptococcal Meningitis in advanced HIV disease at Kitale County Hospital
2. To determine the impact of Cryptococcal Meningitis on people living with advanced HIV Disease
3. To make recommendations based on the outcome of the study
Methods
A retrospective analysis of routinely collected data as from April 2022 to April 2023 at Kitale County Hospital comprehensive Care Clinic Laboratory was performed. All new HIV- positive patients enrolled in care and PLHIV who were lost to follow for more than 6 Months reappearing back at the clinic underwent CD4 count testing; those with CD4 count ≤ 200 cells/μL received reflex Cryptococcal antigen testing The positive serum antigen test was followed by a lumber puncture for CSF Crag. Patients with positive Cryptococcal antigen test were started on treatment as per the Kenya HIV Prevention and Treatment Guidelines, 2022.
Results
Among 2400 patients tested for CD4 between April 2022 to April 2023, 840 had CD4 of less than 200. All the 840 patients with a CD4 <200, were screened for Cryptococcal Antigen. After the screening, 252 patients were positive. This accounted for 30 % of the patients with Cryptococcal Antigenemia; 186 (73.8%) were diagnosed with Cryptoccocal Meningitis, representing 22% of all screened patients. Treatment outcomes were available for all Cryptococcal Meningitis patients: 22 (34%) out of 64 patients who were admitted at inpatients medical Ward died during treatment and 42 (66%) survived until discharge; all the surviving patients remained in HIV care.
Conclussion
It was noted that there was a high prevalence of Cryptococcal meningitis among patients screened at Kitale County Hospital. Cryptoccocal Meningitis Antigen screening was useful in identifying patients with Cryptococcal Meningitis for timely interventions, although mortality remained high among these patients. Therefore, there is need to scale-up Cryptococcal Antigen screening and expanding to other hospitals along with primary health facilities to further improve the care of patients with advanced HIV.
