Abstract Details

Cryptococcal meningitis is a leading cause of mortality in PWH. In Eastern part of India, there is a high prevalence of cryptococcal antigenemia among PWH with CD4+ cells <200 cells/μl.

Comparison of clinical and laboratory parameters among asymptomatic and symptomatic Cryptococcal Meningitis (CM) in newly diagnosed adult Persons with HIV (PWH) with CD4+ cells<200/μl and identification of mortality predictors among CM in PWH.

Serum Cryptococcal Antigen (CrAg) by BIOSYNEX CryptoPS screening was done in 147 newly diagnosed asymptomatic adult PWH with CD4+ cells <200/μl between January 2021 and March 2022. We also received referred patients with symptomatic CM (N=14). Cerebrospinal fluid(CSF) CrAg was tested in all PWH who tested serum CrAg positive. Patients with CSF CrAg positive without symptoms were labelled asymptomatic CM. The clinical, biochemical and mortality parameters of asymptomatic CM were compared with symptomatic CM. Chi-Square and Fischer’s Exact test for categorical data, Student T-test, and Mann Whitney U test for means and medians were done.

9 patients had asymptomatic CM and 18 patients had symptomatic CM. Symptomatic CM had significantly lower CD4+ cells [37.89± 21.01cells/µL, p=0.003], lower CSF glucose [ 39.94 ± 6.80mg/dL, p=0.003] and high CSF cells [104.11 ± 50.39cells/mm³], high CSF protein [130 ± 36.94mg/dL, p=0.001] and coinfection with Tubercular meningitis(TBM) [p=0.008]. All asymptomatic CM patients survived while 4 patients with symptomatic CM died, all of them had TBM also. The predictors of mortality were female gender [p=0.04], low hemoglobin [7.1 ± 2.92 g/dl, p=0.003], high CSF cells [147.5 ± 10.3 cells/mm³, p=0.004], high CSF protein [162 ± 23.3 mg/dl, p= 0.004], high CSF CrAg titre [2500ng/ml, p=0.028], CSF culture positive[p=0.028] and TBM coinfection [p=0.012].

Symptomatic CM is associated with higher mortality. Serum CrAg screening of PWH with CD4+ cells <200 cells/mm³ should be promoted for early identification of asymptomatic CM.