Opportunistic infections (OIs) are common causes of mortality among people living with HIV (PLHIV). We determined prevalence and 30-day mortality due to histoplasmosis, cryptococcosis, and TB in PLHIV with advanced HIV disease (AHD). PLHIV 18 years and older, with a CD4 + T-cell count of less than 350 cells/mm3 newly diagnosed with HIV infection or re-engaged in care after being without ART for more than 90 days (Group A). The second group included symptomatic PLHIV regardless of ART status or CD4 + T-cell count (Group B); all followed for 30 days. Detection of Histoplasma Ag (HisAg) in urine was done by enzyme immunoassay (EIA), Cryptococcus antigen (CrAg) was detected in serum and cerebrospinal fluid (CSF) specimens by lateral flow assay (LFA), and lipoarabinomannan (LAM) detection in urine was by LFA (TB LAM) and in sputum by GeneXpert for diagnosis of Mycobacterium infections. From August 2021 to June 2022, 491 PLHIV were enrolled; 482 (98%) had a CD4 + T-cell result, and 381 patients (79%) were classified with AHD according to CD4 + T-cell count (< 200 CD4/mm3). Frequency of an OI was 38% (n = 145/381). Antigen test positivity rate was 16% (72/467) for TB-LAM, 9% (43/464) for HisAg, and 11% (51/484) for CrAg. Twenty-one of 34 (62%) patients receiving CSF CrAg tests were positive, confirming meningitis. Significant differences in 30-day mortality were observed in patients with an OI (16%) vs. no OI (7%) (p = 0.002). Mortality was highest in patients with histoplasmosis (25%), co-infection (22%), cryptococcosis (18% overall; 19% for cryptococcal meningitis), and TB (10%). TB and fungal OIs, including co-infection, were common in PLHIV in Paraguay and had high associated mortality. Laboratories and health facilities need access to CD4 + T-cell testing and rapid diagnostic assays.

中文翻译：

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在巴拉圭实施针对艾滋病毒感染者的隐球菌病、组织胞浆菌病和结核病的快速诊断检测包

机会性感染 (OIs) 是艾滋病毒感染者 (PLHIV) 死亡的常见原因。我们确定了患有晚期 HIV 疾病 (AHD) 的 PLHIV 患者中组织胞浆菌病、隐球菌病和结核病的患病率和 30 天死亡率。 18 岁及以上、CD4 + T 细胞计数低于 350 个细胞/mm3 的 HIV 感染者，新诊断为 HIV 感染者或在未接受 ART 超过 90 天后重新接受护理（A 组）。第二组包括有症状的 PLHIV，无论 ART 状态或 CD4 + T 细胞计数如何（B 组）；全部随访 30 天。采用酶免疫法（EIA）检测尿液中的组织胞浆菌抗原（HisAg），采用侧流分析（LFA）检测血清和脑脊液（CSF）标本中的隐球菌抗原（CrAg），并检测尿液中的阿拉伯脂甘露聚糖（LAM）通过 LFA (TB LAM) 和 GeneXpert 检测痰液来诊断分枝杆菌感染。 2021年8月至2022年6月，登记了491名艾滋病病毒感染者； 482 名患者 (98%) 获得了 CD4 + T 细胞结果，381 名患者 (79%) 根据 CD4 + T 细胞计数 (< 200 CD4/mm3) 被分类为 AHD。 OI 的发生率为 38% (n = 145/381)。 TB-LAM抗原检测阳性率为16%（72/467），HisAg抗原检测阳性率为9%（43/464），CrAg抗原检测阳性率为11%（51/484）。接受脑脊液 CrAg 检测的 34 名患者中有 21 名 (62%) 呈阳性，证实脑膜炎。成骨不全患者 (16%) 与无成骨不全患者 (7%) 的 30 天死亡率存在显着差异 (p = 0.002)。组织胞浆菌病 (25%)、合并感染 (22%)、隐球菌病 (总体为 18%；隐球菌性脑膜炎为 19%) 和结核病 (10%) 患者的死亡率最高。结核病和真菌性感染，包括混合感染，在巴拉圭艾滋病病毒感染者中很常见，并且相关死亡率很高。实验室和卫生机构需要获得 CD4 + T 细胞检测和快速诊断测定。