Immunological and clinical profiles of asymptomatic cryptococcal antigenemia in HIV/AIDS patients in Uganda

Abstract

Cryptococcal meningitis (CM), which is caused by the fungus, Cryptococcus Neoformans, causes life-threatening inflammation of the meninges and sometimes inflammation of the brain parenchyma. Asymptomatic cryptococcal antigenemia (CA) precedes CM by a median period of about 22days and an independent predictor of mortality in otherwise asymptomatic HIV patients. Without treatment with anti-fungal treatmentand/or ART, 100% of individuals with asymptomatic antigenemia progress to CM, however, even on treatment, about 28% progress to CM. These observations suggest that host immune responses and not just antigen burden are pivotal in the control of cryptococcal infection. The specific immunological responses important for CA control remain poorly understood. A better understanding of the immunological processes in cryptococcal infection could help predict progression from asymptomatic disease to overt cryptococcal meningitis. It could also inform us on the potential for developing immune therapies in the management of cryptococcal infection.