HIV感染者中与隐球菌荚膜抗原阳性相关的因素：一项回顾性观察队列研究。
Factors associated with cryptococcal capsular antigen positivity among people living with HIV: a retrospective observational cohort study.
作者信息
Da Fenqi, Cao Yi, Guo Pengle, Zhang Yeyang, He Yaozu, Li Quanmin, Tan Weiran, Hou Huijun, Tang Xiaoping, Zhao Heping, Li Linghua
机构信息
Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, 510440, China.
Guangzhou Medical Research Institute of Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangdong, Guangzhou, China.
出版信息
BMC Infect Dis. 2025 Aug 13;25(1):1014. doi: 10.1186/s12879-025-11417-0.
BACKGROUND
Cryptococcosis, which is caused by Cryptococcus, is an aggressive fungal disease posing a high mortality risk among people living with HIV (PLHIV). However, factors associated with cryptococcal capsular antigen (CrAg) positivity among PLHIV remain unclear.
METHODS
We recruited PLHIV from the Guangzhou Eighth People's Hospital between March 2018 and December 2019. Serum CrAg was qualitatively detected using Lateral Flow Assay. Fungal culture and pathological examinations were performed on cerebrospinal fluid. Chi-squared tests and multivariable logistic regression were used to identify factors associated with CrAg positivity.
RESULTS
A total of 1478 PLHIV were included, among whom 297 (20.1%) were antiretroviral therapy-naïve (ART-naïve), 1181 (79.9%) were ART-experienced. The median baseline CD4 + T cell count was 43 cells/μl (interquartile range [IQR]:13-117). The overall CrAg positivity rate was 5.1%, with 94.7% of CrAg-positive individuals having baseline CD4 + counts ≤ 200 cells/μl. CrAg positivity was 6.4% among ART-naïve and 4.7% among ART-experienced PLHIV. Notably, within the ART-experienced group, CrAg-positive PLHIV displayed lower baseline and latest CD4 + T cell counts than those in CrAg-negative PLHIV. CrAg status was significantly associated with shorter ART duration (≤ 1 year vs. > 2 year: adjusted odds ratio [aOR], 2.53; 95% confidence interval [CI], 1.20-5.34. 1-2 year vs. > 2 year: 4.61, 2.10-10.12) and other OIs (2.56, 1.41-4.63) among ART-experienced PLHIV.
CONCLUSIONS
A considerable CrAg positivity rate was observed among both ART-naïve and ART-experienced PLHIV. CD4 + T cell count ≤ 200 cells/μl, shorter ART duration, and presence of other opportunistic infections were all significantly associated with CrAg positivity. These findings support extending serum CrAg screening to all PLHIV with CD4 + counts ≤ 200 cells/μl, regardless of ART status, to improve early detection and reduce cryptococcosis-related mortality.
背景
隐球菌病由隐球菌引起，是一种侵袭性真菌病，在人类免疫缺陷病毒（HIV）感染者（PLHIV）中具有较高的死亡风险。然而，PLHIV中与隐球菌荚膜抗原（CrAg）阳性相关的因素仍不清楚。
方法
我们于2018年3月至2019年12月期间从广州市第八人民医院招募PLHIV。采用侧向流动分析法对血清CrAg进行定性检测。对脑脊液进行真菌培养和病理检查。采用卡方检验和多变量逻辑回归来确定与CrAg阳性相关的因素。
结果
共纳入1478例PLHIV，其中297例（20.1%）未接受过抗逆转录病毒治疗（ART-naïve），1181例（79.9%）有ART经验。基线CD4 + T细胞计数的中位数为43个细胞/μl（四分位间距[IQR]：13 - 117）。总体CrAg阳性率为5.1%，94.7%的CrAg阳性个体基线CD4 + 计数≤200个细胞/μl。未接受过ART治疗的PLHIV中CrAg阳性率为6.4%，有ART经验的PLHIV中为4.7%。值得注意的是，在有ART经验的组中，CrAg阳性的PLHIV的基线和最新CD4 + T细胞计数低于CrAg阴性的PLHIV。在有ART经验的PLHIV中，CrAg状态与较短的ART疗程（≤1年 vs. >2年：调整后的优势比[aOR]，2.53；95%置信区间[CI]，1.20 - 5.34。1 - 2年 vs. >2年：4.61，2.10 - 10.1）和其他机会性感染（2.56，1.41 - 4.63）显著相关。
结论
在未接受过ART治疗和有ART经验的PLHIV中均观察到相当高的CrAg阳性率。CD4 + T细胞计数≤200个细胞/μl、较短的ART疗程以及存在其他机会性感染均与CrAg阳性显著相关。这些发现支持将血清CrAg筛查扩展至所有CD4 + 计数≤200个细胞/μl的PLHIV，无论其ART状态如何，以改善早期检测并降低隐球菌病相关死亡率。
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