Cryptococcal antigenemia detected in 11.1% of hospitalized advanced-HIV patients in Ceará study

A retrospective, cross-sectional study conducted in a tertiary hospital in Fortaleza, Ceará, Brazil, found serum cryptococcal antigen in 7 of 63 hospitalized patients with advanced HIV infection between 2020 and 2022, a prevalence of 11.1%. The research, summarized in the study abstract, also found that antigen-positive patients had a sixfold higher risk of death during hospitalization than antigen-negative patients. The observational findings identify an association and do not establish that antigenemia caused the deaths.

The investigators reviewed epidemiological, clinical and laboratory information from medical records and tested serum samples using a qualitative lateral-flow cryptococcal antigen assay. The sample included 63 patients, of whom 77.8% were men. Median age was 38 years, median CD4+ cell count was 33 cells/µL, with an interquartile range of 12.5–85.5, and the median logarithmic viral load was 4.95, with an interquartile range of 4.21–5.53. Among patients with CD4+ counts below 100 cells/µL, antigenemia was detected in four of 47, or 8.5%.

Six antigen-positive patients underwent lumbar puncture for cerebrospinal fluid collection. Cryptococcal meningitis was confirmed in one of them, representing 16.7% of those tested, while another patient had disseminated cryptococcal disease. Isolated cryptococcal antigenemia, without evidence of cryptococcal disease, was identified in five patients, or 7.9% of the full study population. The abstract reports that two patients died during hospitalization without evidence of cryptococcal disease. Two asymptomatic patients received fluconazole as pre-emptive treatment, and one received no antifungal drugs; none developed cryptococcal meningitis during the 12 months after discharge.

These results are limited to the small, single-hospital retrospective sample and the follow-up reported in the abstract. The study did not assess a broader population, and the absence of cryptococcal meningitis during follow-up applies only to the three antigen-positive patients whose discharge treatment was described. The authors concluded that cryptococcal antigen screening should be available for all patients in regions where the burden of cryptococcal disease among people living with HIV is high. The findings support that conclusion for the setting studied, but the abstract does not provide data on screening uptake, diagnostic delays, barriers to care or the effectiveness of screening across other hospitals or regions.

Subject of Research: Prevalence and management of cryptococcal antigenemia in hospitalized patients with advanced HIV in Ceará, Brazil

Article Title: Prevalence and management of cryptococcal antigenemia in hospitalized patients with advanced HIV infection in a tertiary hospital from Fortaleza, Ceará, Brazil between 2020 and 2022

Article References: Damasceno, L. S., Almeida Júnior, A. M. B. D., Brito, J. D. N., Maciel, L. S., Magalhães, L. F., & Mesquita, J. R. L. D. (2026). Prevalence and management of cryptococcal antigenemia in hospitalized patients with advanced HIV infection in a tertiary hospital from Fortaleza, Ceará, Brazil between 2020 and 2022. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14554-2

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14554-2

Keywords: cryptococcal antigenemia, advanced HIV, cryptococcal meningitis, hospital epidemiology, Ceará, Fortaleza, serum screening, in-hospital mortality, retrospective study, Prevalence, management, cryptococcal