Annual candidemia incidence rates per 100,000 person-years, by year and age-group in the Metropolitan Baltimore area.

<p>Annual candidemia incidence rates per 100,000 person-years, by year and age-group in the Metropolitan Baltimore area.</p

Candidemia cases that had a CVC compared with cases that had no CVC, in Atlanta (ATL) and Baltimore (BTM), 2008–2013.

<p>Candidemia cases that had a CVC compared with cases that had no CVC, in Atlanta (ATL) and Baltimore (BTM), 2008–2013.</p

Changes in candidemia case count at participating hospitals over the five-year study period (2008–2013), by the total number of cases each hospital contributed during the study.

<p>Changes in candidemia case count at participating hospitals over the five-year study period (2008–2013), by the total number of cases each hospital contributed during the study.</p

Selected characteristics of patients with candidemia in Atlanta and Baltimore metropolitan areas.

<p>*16/17 isolates were <i>C</i>. <i>glabrata</i> species</p><p>Selected characteristics of patients with candidemia in Atlanta and Baltimore metropolitan areas.</p

Annual candidemia incidence rates per 100,000 person-years, by year and age-group in the Metropolitan Atlanta area.

<p>Annual candidemia incidence rates per 100,000 person-years, by year and age-group in the Metropolitan Atlanta area.</p

Annual candidemia incidence rates per 100,000 person-years, by year and location, 2008–2013.

<p>Annual candidemia incidence rates per 100,000 person-years, by year and location, 2008–2013.</p

Selected characteristics of candidemia patients by year of surveillance, in Atlanta (ATL) and Baltimore (BTM) metropolitan areas.

<p><b><i>Note</i>:</b><i>HO</i>, <i>healthcare onset</i>. <i>HACO</i>, <i>healthcare-associated community-onset</i>. <i>CA</i>, <i>community-acquired</i>. <i>Ab surgery</i>, <i>abdominal surgery</i>. <i>Y</i>, <i>year</i>.</p><p>Selected characteristics of candidemia patients by year of surveillance, in Atlanta (ATL) and Baltimore (BTM) metropolitan areas.</p

Prevalence and correlates of CrAg positivity among HIV-infected adults with advanced immunosuppression in Namibia, 2013–14.

<p>Prevalence and correlates of CrAg positivity among HIV-infected adults with advanced immunosuppression in Namibia, 2013–14.</p

Select demographic and clinical characteristics of sampled patients, sero-survey of <i>Cryptococcus</i> antigenemia among HIV-infected adults with advanced immunosuppression in Namibia, 2013–14.

<p>Select demographic and clinical characteristics of sampled patients, sero-survey of <i>Cryptococcus</i> antigenemia among HIV-infected adults with advanced immunosuppression in Namibia, 2013–14.</p

Estimated Prevalence of <i>Cryptococcus</i> Antigenemia (CrAg) among HIV-Infected Adults with Advanced Immunosuppression in Namibia Justifies Routine Screening and Preemptive Treatment

<div><p>Background</p><p>Cryptococcal meningitis is common and associated with high mortality among HIV infected persons. The World Health Organization recommends that routine Cryptococcal antigen (CrAg) screening in ART-naïve adults with a CD4⁺ count <100 cells/μL followed by pre-emptive antifungal therapy for CrAg-positive patients be considered where CrAg prevalence is ≥3%. The prevalence of CrAg among HIV adults in Namibia is unknown. We estimated CrAg prevalence among HIV-infected adults receiving care in Namibia for the purpose of informing routine screening strategies.</p><p>Methods</p><p>The study design was cross-sectional. De-identified plasma specimens collected for routine CD4⁺ testing from HIV-infected adults enrolled in HIV care at 181 public health facilities from November 2013 to January 2014 were identified at the national reference laboratory. Remnant plasma from specimens with CD4⁺ counts <200 cells/μL were sampled and tested for CrAg using the IMMY^® Lateral Flow Assay. CrAg prevalence was estimated and assessed for associations with age, sex, and CD4⁺ count.</p><p>Results</p><p>A total of 825 specimens were tested for CrAg. The median (IQR) age of patients from whom specimens were collected was 38 (32–46) years, 45.9% were female and 62.9% of the specimens had CD4 <100 cells/μL. CrAg prevalence was 3.3% overall and 3.9% and 2.3% among samples with CD4⁺ counts of CD4⁺<100 cells/μL and 100–200 cells/μL, respectively. CrAg positivity was significantly higher among patients with CD4+ cells/μL < 50 (7.2%, P = 0.001) relative to those with CD4 cells/μL 50–200 (2.2%).</p><p>Conclusion</p><p>This is the first study to estimate CrAg prevalence among HIV-infected patients in Namibia. CrAg prevalence of ≥3.0% among patients with CD4⁺<100 cells/μL justifies routine CrAg screening and preemptive treatment among HIV-infected in Namibia in line with WHO recommendations. Patients with CD4⁺<100 cells/μL have a significantly greater risk for CrAg positivity. Revised guidelines for ART in Namibia now recommend routine screening for CrAg.</p></div