sj-docx-1-tai-10.1177_20499361241228341 – Supplemental material for Preference for long-acting injectable for ART and PrEP among people with and without HIV: a cross-sectional study in Argentina

Supplemental material, sj-docx-1-tai-10.1177_20499361241228341 for Preference for long-acting injectable for ART and PrEP among people with and without HIV: a cross-sectional study in Argentina by Sergio Sciannameo, Virginia Zalazar, Luciana Spadaccini, Mariana Duarte, Pedro Cahn, Ines Aristegui and Omar Sued in Therapeutic Advances in Infectious Disease</p

Prevalence of cryptococcal infection among advanced HIV patients in Argentina using lateral flow immunoassay

<div><p>Background</p><p>Globally, Latin America ranks third among regions with most cases of AIDS related cryptococcal meningitis. In 2009, a lateral flow immunoassay (LFA) for the detection of cryptococcal antigen (CrAg) was developed as a potential point-of-care test for diagnosis of cryptococcal infection. In 2011 World Health Organizations recommended on CrAg screening for HIV positive persons with CD4 below 100 cells/μL, followed by preemptive fluconazole treatment. However, in Argentina no formal recommendations for CrAg screening have been issued.</p><p>Methods</p><p>HIV positive patients > = 18 years with advanced immunosuppression (CD4 counts ≤100 cells/μL within 3 months or WHO stage III/IV), who visited the hospital between April 1, 2014 and January 31, 2015, were included. The LFA was performed according to the manufacturer’s instructions on all serum samples. When CrAg detection was positive, a lumbar puncture was performed to rule out cryptococcal meningitis. Patients without evidence of meningeal involvement were treated with preemptive oral fluconazole in ambulatory care.</p><p>Results</p><p>We included 123 patients. Prevalence of CrAg-positivity was 8.1%. Among the 10 CrAg-positive patients, 6 had meningeal involvement detected through the CSF analysis (CSF India-ink testing, CSF CrAg and culture). The remaining 4 patients with positive CrAg received targeted preemptive treatment with oral fluconazole and were free of cryptococcal disease during the follow-up period. None of the 113 patients with a negative CrAg test result developed cryptococcal disease.</p><p>Conclusions</p><p>This is the first study in Argentina, to our knowledge, describing the prevalence of cryptococcosis and usefulness of CrAg screening. LFA provided early diagnosis to determine a high prevalence of CrAg in our hospital, and that screening for subclinical infection with preemptive antifungal treatment, prevented a substantial proportion of meningeal disease.</p></div

Baseline characteristics of the cohort^a.

<p>Baseline characteristics of the cohort<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0178721#t001fn002" target="_blank">^a</a>.</p

Results of key virologic endpoints from identified trials in ARV-naive patients¹.

<p>Results of key virologic endpoints from identified trials in ARV-naive patients<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0148231#t002fn002" target="_blank">¹</a>.</p

Flow chart of the specimen testing algorithm.

<p>Flow chart of the specimen testing algorithm.</p

Study designs for identified trials in ARV-naive patients.

<p>Study designs for identified trials in ARV-naive patients.</p

Results of key secondary endpoints from identified trials among ARV-experienced HIV-suppressed patients.

<p>Results of key secondary endpoints from identified trials among ARV-experienced HIV-suppressed patients.</p

Efficacy of therapy by regimen in A) in ARV-naive, and B) ARV-experienced, virologically suppressed patients.

<p>Percentage indicated shows subjects with HIV-1 RNA <50 copies/mL at week 48. Studies that were randomised and sufficiently powered for direct comparison of standard and dual therapy regimens are shaded. ¹<48 copies/mL; ²at 96 weeks; ³<40 copies/mL; ⁴at 96 weeks; ⁵<48 copies/mL; ⁶at 96 weeks; ⁷at 24 months; ⁸at 12 months; ⁹at week 24; ¹⁰<80 copies/mL. ARV, antiretroviral.</p

Detail of the INPUTS for the model.

<p>Detail of the INPUTS for the model.</p

Study designs for identified trials in ARV-experienced, virologically suppressed patients.

<p>Study designs for identified trials in ARV-experienced, virologically suppressed patients.</p