2026-06-14T03:45:05Zhttps://repisalud.isciii.es/rest/oai/requestoai:repisalud.isciii.es:20.500.12105/114542024-09-27T21:56:27Zcom_20.500.12105_2052com_20.500.12105_2051col_20.500.12105_19609
Repisalud
author
Medina, Narda
author
Alastruey-Izquierdo, Ana
author
Bonilla, Oscar
author
Pérez, Juan C
author
Aguirre, Luis
author
Samayoa, Blanca
author
Arathoon, Eduardo
author
Denning, David W
author
Rodriguez-Tudela, Juan Luis
author
Mercado, Danicela
author
Fungired
funder
Global Action Fund for Fungal Infections
funder
AIDS Healthcare Foundation
funder
Fondation JYLAG
2020-11-27T09:01:34Z
2020-11-27T09:01:34Z
2020
AIDS. 2020 Sep 1;34(11):1625-1632.
10.1097/QAD.0000000000002631
1473-5571
AIDS (London, England)
32694415
http://hdl.handle.net/20.500.12105/11454
Objectives: We evaluated the comparative performance of different assays used in a Diagnostic Laboratory Hub that linked 13 HIV healthcare facilities for the diagnosis of tuberculosis (TB), histoplasmosis, and cryptococcosis, and describing its functions in Guatemala compared with other National Reference Laboratories. Methods: The following diagnostic techniques were analyzed in 24 months (2017-2018) in a cohort of patients with HIV: smear microscopy, mycobacterial and fungal cultures, isolator blood culture, PCR assays, and antigen detection tests. Results: A total of 4245 patients were included, 716 (16.2%) had an opportunistic infection: 249 (34.7%) TB, 40 (5.6%) nontuberculous mycobacteria, 227 (31.7%) histoplasmosis, 138 (19.3%) cryptococcosis, and 62 (8.6%) had multiple opportunistic infections. Two hundred sixty-three [92.6%; 95% confidence interval (CI), 89-95.1] of TB cases were diagnosed by PCR. Urine antigen assay detected 94% (95% CI, 89-96) of the disseminated histoplasmosis cases. A lateral flow assay to detect cryptococcal antigen diagnosed 97% (95% CI, 93.3-98.7%) of the cryptococcal cases. In 85 patients (51.5%) with a cerobrospinal fluid sample, cryptococcal meningitis was diagnosed in 55 (64.7%), of which 18 (32.7%) were only detected by cryptococcal antigen. Conclusion: Validated commercial antigen tests, as used in this program, should be the new gold standard for histoplasmosis and cryptococcosis diagnosis. In their absence, 35% of disseminated histoplasmosis and 32.7% of cryptococcal meningitis cases would have been missed. Patients with multiple opportunistic infections were frequently diagnosed and strategies should be designed to screen patients irrespective of their clinical presentation. In low resource settings, Diagnostic Laboratory Hubs can deliver quality diagnostics services in record time at affordable prices.
eng
Laboratory diagnosis
Opportunistic infections
Tuberculosis
Histoplasmosis
Cryptococcosis
Comparative performance of the laboratory assays used by a Diagnostic Laboratory Hub for opportunistic infections in people living with HIV
research article
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ComparativePerformanceOfThe_2020.pdf.txt
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