Prevalence and factors associated with Aspergillus galactomannan antigenemia among People Living with Advanced HIV Disease in Uganda

Background Invasive aspergillosis is a severe fungal disease mostly seen in severely immunocompromised hosts, including persons living with HIV/AIDS, with a high mortality rate. The detection of galactomannan (GM) is more sensitive than fungal cultures in diagnosis of invasive aspergillosis. We piloted the sōna Aspergillus GM Lateral Flow Assay (LFA) 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 nine health facilities in Uganda. Persons presenting with AHD were consecutively enrolled. Data were collected using an interviewer-administered questionnaire, while samples; serum and sputum were tested both on-site and at the Central Public Health Laboratories using the sōna Aspergillus GM LFA 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 119/332 (36%) of participants. Among 26 samples with Aspergillus growth; 30.8% were A. terreus, 26.9% were A. flavus, 26.9% were A. niger, 11.5% were A. fumigatus and 3.8% were A. lentulus. Being an in-patient (aOR 2.2, 95%CI=1.3-4.5) and having HIV WHO stage 3/4 (aOR 3.9, 95%CI=1.2-13.0) were independently associated with Aspergillus GM antigenemia. Conclusion A 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 in order to determine the burden of aspergillosis among people living with AHD in Uganda.