The Diagnostic Laboratory Hub: A New Health Care System Reveals the Incidence and Mortality of Tuberculosis, Histoplasmosis, and Cryptococcosis of PWH in Guatemala
Author:
Samayoa B1, Aguirre L1, Bonilla O2, Medina N1, Lau-Bonilla D1, Mercado D2, Moller A1, Perez J C2, Alastruey-Izquierdo A3ORCID, Arathoon E2, Denning D W45, Rodríguez-Tudela J L5, López Pérez Oscar Eduardo, Ortiz Barrientos Brenan, Reyes Muñoz Vilma Alejandrina, Sajché Aguilar Gladys, Méndez Andrade Aura Marina, de León Luis Roberto Santa Marina, Gómez Alcázar Ana Lucía, González Eduardo Celada, Quiñónez M Gustavo A, Cuyuch Sontay Germán Orlando, Contreras Marín Alba Virtud, Fong Araujo María de Lourdes, Mazariegos L Claudia, Guzmán Brenda,
Affiliation:
1. Asociación de Salud Integral, Guatemala, Guatemala 2. Clínica Familiar “Luis Angel García”/Hospital General San Juan de Dios, Guatemala, Guatemala 3. Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain 4. The University of Manchester and the National Aspergillosis Centre, Wythenshawe Hospital, Manchester, UK 5. Global Action Fund for Fungal Infections, Geneva, Switzerland
Abstract
Abstract
Background
A Diagnostic Laboratory Hub (DLH) was set up in Guatemala to provide opportunistic infection (OI) diagnosis for people with HIV (PWH).
Methods
Patients newly presenting for HIV, PWH not receiving antiretrovirals (ARVs) for >90 days but returned to care (Return/Restart), and PWH on ARVs with symptoms of OIs (ARV treatment) were prospectively included. Screening for tuberculosis, nontuberculous mycobacteria (NTM), histoplasmosis, and cryptococcosis was done. Samples were couriered to the DLH, and results were transmitted electronically. Demographic, diagnostic results, disease burden, treatment, and follow-up to 180 days were analyzed.
Results
In 2017, 1953 patients were included, 923 new HIV infections (an estimated 44% of all new HIV infections in Guatemala), 701 on ARV treatment, and 315 Return/Restart. Three hundred seventeen (16.2%) had an OI: 35.9% tuberculosis, 31.2% histoplasmosis, 18.6% cryptococcosis, 4.4% NTM, and 9.8% coinfections. Histoplasmosis was the most frequent AIDS-defining illness; 51.2% of new patients had <200 CD4 cells/mm3 with a 29.4% OI incidence; 14.3% of OIs in new HIV infections occurred with CD4 counts of 200–350 cells/mm3. OIs were the main risk factor for premature death for new HIV infections. At 180 days, patients with OIs and advanced HIV had 73-fold greater risk of death than those without advanced disease who were OI-free.
Conclusions
The DLH OI screening approach provides adequate diagnostic services and obtains relevant data. We propose a CD4 screening threshold of <350 cells/mm3. Mortality remains high, and improved interventions are required, including expansion of the DLH and access to antifungal drugs, especially liposomal amphotericin B and flucytosine.
Funder
Global Action Fund for Fungal Infections and JYLAG AIDS Health Foundation Intrahealth International and Ministry of health in Guatemala
Publisher
Oxford University Press (OUP)
Subject
Infectious Diseases,Oncology
Cited by
24 articles.
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