{"title":"艾滋病毒感染者 CD4 细胞计数快速测定及隐球菌和组织胞浆菌抗原检测：在阿根廷试点研究中实施一揽子护理战略","authors":"","doi":"10.1016/j.ijregi.2024.100403","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><p>Despite advancements in HIV diagnosis and treatment, advanced HIV disease (AHD) is still a significant concern worldwide, especially in countries with a high percentage of undiagnosed cases and late-stage diagnoses.</p></div><div><h3>Methods</h3><p>A prospective pilot study was conducted in Buenos Aires, Argentina to assess the feasibility of implementing a package for people living with HIV, integrating a point-of-care clusters of differentiation (CD4) test, followed by rapid <em>Cryptococcus</em> and <em>Histoplasma</em> antigen (Ag) detection.</p></div><div><h3>Results</h3><p>A total of 105 people living with HIV were enrolled, during June 2021 to October 2021. The VISITECT CD4 Advanced Disease Lateral Flow Assay (CD4-LFA) (Accubio) classified 98 (93%) patients with AHD. Compared with flow cytometry, the CD4-LFA performed with a high sensitivity (100%) but low specificity (19%) and limited accuracy (47%). In the 98 patients classified with AHD using the CD4-LFA, 16 tested positive for any of the rapid Ag used, including 12 patients positive for the <em>Histoplasma</em> Ag test and four positive for <em>Cryptococcus</em> Ag; all four patients with positive <em>Cryptococcus</em> Ag in sera and were diagnosed with meningitis. In the 30-day follow-up, one death was recorded.</p></div><div><h3>Conclusions</h3><p>The CD4-LFA correctly classified all patients with CD4 ≤200 cells/µL by flow cytometry, but a high frequency of patients misclassified with AHD was recorded. We also observed a high prevalence of opportunistic fungal infections, as previously observed in the hospital where this pilot study was conducted; however, in contrast with those previous reports, mortality was lower. The study underscores the importance of scaling up comprehensive care strategies and collaborating with governmental and non-governmental partners to enhance access to essential diagnostic tools and treatments for people living with HIV. Further research with larger sample sizes is needed to validate these findings.</p></div>","PeriodicalId":73335,"journal":{"name":"IJID regions","volume":null,"pages":null},"PeriodicalIF":1.5000,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772707624000742/pdfft?md5=10937366510e9dc23aa305f9413cce21&pid=1-s2.0-S2772707624000742-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Rapid CD4 cell count determination and Cryptococcus and Histoplasma antigen detection in people living with HIV: Implementation of a package of care strategy in a pilot study, Argentina\",\"authors\":\"\",\"doi\":\"10.1016/j.ijregi.2024.100403\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objectives</h3><p>Despite advancements in HIV diagnosis and treatment, advanced HIV disease (AHD) is still a significant concern worldwide, especially in countries with a high percentage of undiagnosed cases and late-stage diagnoses.</p></div><div><h3>Methods</h3><p>A prospective pilot study was conducted in Buenos Aires, Argentina to assess the feasibility of implementing a package for people living with HIV, integrating a point-of-care clusters of differentiation (CD4) test, followed by rapid <em>Cryptococcus</em> and <em>Histoplasma</em> antigen (Ag) detection.</p></div><div><h3>Results</h3><p>A total of 105 people living with HIV were enrolled, during June 2021 to October 2021. The VISITECT CD4 Advanced Disease Lateral Flow Assay (CD4-LFA) (Accubio) classified 98 (93%) patients with AHD. Compared with flow cytometry, the CD4-LFA performed with a high sensitivity (100%) but low specificity (19%) and limited accuracy (47%). In the 98 patients classified with AHD using the CD4-LFA, 16 tested positive for any of the rapid Ag used, including 12 patients positive for the <em>Histoplasma</em> Ag test and four positive for <em>Cryptococcus</em> Ag; all four patients with positive <em>Cryptococcus</em> Ag in sera and were diagnosed with meningitis. In the 30-day follow-up, one death was recorded.</p></div><div><h3>Conclusions</h3><p>The CD4-LFA correctly classified all patients with CD4 ≤200 cells/µL by flow cytometry, but a high frequency of patients misclassified with AHD was recorded. We also observed a high prevalence of opportunistic fungal infections, as previously observed in the hospital where this pilot study was conducted; however, in contrast with those previous reports, mortality was lower. The study underscores the importance of scaling up comprehensive care strategies and collaborating with governmental and non-governmental partners to enhance access to essential diagnostic tools and treatments for people living with HIV. 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引用次数: 0
摘要
目的尽管艾滋病诊断和治疗取得了进步，但晚期艾滋病（AHD）仍然是全世界关注的一个重要问题，尤其是在未确诊病例和晚期确诊病例比例较高的国家。方法 在阿根廷布宜诺斯艾利斯开展了一项前瞻性试点研究，以评估为艾滋病病毒感染者实施套餐的可行性，该套餐整合了护理点分化群（CD4）检测，以及隐球菌和组织胞浆菌抗原（Ag）的快速检测。结果 在 2021 年 6 月至 2021 年 10 月期间，共有 105 名艾滋病病毒感染者参加了研究。VISITECT CD4晚期疾病侧流检测法（CD4-LFA）（Accubio）对98名（93%）AHD患者进行了分类。与流式细胞术相比，CD4-LFA灵敏度高（100%），但特异性低（19%），准确性有限（47%）。在使用 CD4-LFA 诊断出的 98 名 AHD 患者中，有 16 人的任何一种快速 Ag 检测呈阳性，其中 12 人的组织胞浆菌 Ag 检测呈阳性，4 人的隐球菌 Ag 检测呈阳性；这 4 名患者的血清中隐球菌 Ag 均呈阳性，被诊断为脑膜炎。结论 CD4-LFA 能通过流式细胞术正确分类 CD4 ≤200 cells/µL 的所有患者，但被误诊为 AHD 的患者频率很高。我们还观察到机会性真菌感染的高发病率，这与之前在进行这项试点研究的医院中观察到的情况相同；不过，与之前的报告相比，死亡率较低。这项研究强调了扩大综合护理战略的规模以及与政府和非政府合作伙伴合作以增加艾滋病毒感染者获得基本诊断工具和治疗的机会的重要性。要验证这些研究结果，还需要进行样本量更大的进一步研究。
Rapid CD4 cell count determination and Cryptococcus and Histoplasma antigen detection in people living with HIV: Implementation of a package of care strategy in a pilot study, Argentina
Objectives
Despite advancements in HIV diagnosis and treatment, advanced HIV disease (AHD) is still a significant concern worldwide, especially in countries with a high percentage of undiagnosed cases and late-stage diagnoses.
Methods
A prospective pilot study was conducted in Buenos Aires, Argentina to assess the feasibility of implementing a package for people living with HIV, integrating a point-of-care clusters of differentiation (CD4) test, followed by rapid Cryptococcus and Histoplasma antigen (Ag) detection.
Results
A total of 105 people living with HIV were enrolled, during June 2021 to October 2021. The VISITECT CD4 Advanced Disease Lateral Flow Assay (CD4-LFA) (Accubio) classified 98 (93%) patients with AHD. Compared with flow cytometry, the CD4-LFA performed with a high sensitivity (100%) but low specificity (19%) and limited accuracy (47%). In the 98 patients classified with AHD using the CD4-LFA, 16 tested positive for any of the rapid Ag used, including 12 patients positive for the Histoplasma Ag test and four positive for Cryptococcus Ag; all four patients with positive Cryptococcus Ag in sera and were diagnosed with meningitis. In the 30-day follow-up, one death was recorded.
Conclusions
The CD4-LFA correctly classified all patients with CD4 ≤200 cells/µL by flow cytometry, but a high frequency of patients misclassified with AHD was recorded. We also observed a high prevalence of opportunistic fungal infections, as previously observed in the hospital where this pilot study was conducted; however, in contrast with those previous reports, mortality was lower. The study underscores the importance of scaling up comprehensive care strategies and collaborating with governmental and non-governmental partners to enhance access to essential diagnostic tools and treatments for people living with HIV. Further research with larger sample sizes is needed to validate these findings.
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