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Prevalence and Factors Associated With Aspergillus galactomannan Antigenemia Among People With Advanced HIV Disease in Uganda, 2023

Year: 2025

Type: article

Abstract: Background Invasive aspergillosis is a severe fungal disease with a high mortality rate, mostly seen in severely immunocompromised hosts, including persons with HIV/AIDS. The detection of galactomannan (GM) antigen is more sensitive than fungal cultures in diagnosis of invasive aspergillosis. We conducted a pilot study using the sōna Aspergillus GM Lateral Flow Assay on serum among people with advanced HIV disease (AHD) in Uganda to estimate the prevalence and factors associated with Aspergillus GM antigenemia in this population. Methods This was a cross-sectional study conducted at 9 health facilities in Uganda in 2023. Persons presenting with AHD (CD4<200 cells/mm3) were consecutively enrolled. Data were collected using an interviewer-administered questionnaire, serum and sputum samples were tested both onsite and at the Central Public Health Laboratories using the sōna Aspergillus GM Lateral Flow Assay and culture, respectively. Logistic regression was performed at a 95% confidence intervals (CI) to assess the factors associated with Aspergillus GM antigenemia. Data were analyzed using SAS 9.4. Results Aspergillus GM antigenemia was present in 119 of 332 (35.8%) of participants. Among 26 samples with Aspergillus growth, 30.8% were Aspergillus terreus, 26.9% were Aspergillus flavus, 26.9% were Aspergillus niger, 11.5% were Aspergillus fumigatus, and 3.8% were Aspergillus lentulus. Being an inpatient (adjusted odds ratio, 2.2; 95% CI, 1.3–4.5) and having HIV World Health Organization stage 3 or 4 disease (adjusted odds ratio, 3.9; 95% CI, 1.2–13.0) were independently associated with Aspergillus GM antigenemia. Conclusions The high Aspergillus GM antigenemia of about 4 in 10 persons with AHD in Uganda may suggest a high burden of aspergillosis in this population. There is urgent need for further definitive studies incorporating host factors, clinical factors and radiological imaging to determine the burden of aspergillosis among people with AHD in Uganda.

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofaf620