{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T01:03:50Z","timestamp":1768871030379,"version":"3.49.0"},"reference-count":45,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2020,3,20]],"date-time":"2020-03-20T00:00:00Z","timestamp":1584662400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Mycoses"],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Despite widespread access to antiretroviral therapy (ART), the burden of advanced HIV disease in South Africa is high. This translates into an increased risk of AIDS\u2010related opportunistic infections, including invasive mycoses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using a limited number of non\u2010culture\u2010based diagnostic assays, we aimed to determine the prevalence of invasive mycoses and tuberculosis among hospitalised adults with very advanced HIV (CD4 counts\u00a0&lt;\u00a0100\u00a0cells\/\u00b5L) at a large academic hospital. We conducted interviews and prospective medical chart reviews. We performed point\u2010of\u2010care finger stick and serum cryptococcal antigen lateral flow assays; serum (1 \u2192 3) \u00df\u2010D\u2010glucan assays; urine <jats:italic>Histoplasma<\/jats:italic> galactomannan antigen enzyme immunoassays and TB lipoarabinomannan assays.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We enrolled 189 participants from 5280 screened inpatients. Fifty\u2010eight per cent were female, with median age 37\u00a0years (IQR: 30\u201043) and median CD4 count 32\u00a0cells\/\u00b5L (IQR: 13\u201063). At enrolment, 60% (109\/181) were receiving ART. Twenty\u2010one participants (11%) had a diagnosis of an invasive mycosis, of whom 53% (11\/21) had cryptococcal disease. Thirteen participants (7%) had tuberculosis and a concurrent invasive mycosis. ART\u2010experienced participants were 60% less likely to have an invasive mycosis than those ART\u2010na\u00efve (adjusted OR: 0.4; 95% CI 0.15\u20101.0; <jats:italic>P<\/jats:italic>\u00a0=\u00a0.03). Overall in\u2010hospital mortality was 13% (invasive mycosis: 10% [95% CI 1.2\u201030.7] versus other diagnoses: 13% (95% CI 8.4\u201019.3)).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>One in ten participants had evidence of an invasive mycosis. Diagnosis of proven invasive fungal disease and differentiation from other opportunistic infections was challenging. More fungal\u2010specific screening and diagnostic tests should be applied to inpatients with advanced HIV disease.<\/jats:p><\/jats:sec>","DOI":"10.1111\/myc.13071","type":"journal-article","created":{"date-parts":[[2020,3,3]],"date-time":"2020-03-03T13:16:54Z","timestamp":1583241414000},"page":"478-487","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Screening for invasive fungal disease using non\u2010culture\u2010based assays among inpatients with advanced HIV disease at a large academic hospital in South Africa"],"prefix":"10.1111","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2411-2483","authenticated-orcid":false,"given":"Erika","family":"van Schalkwyk","sequence":"first","affiliation":[{"name":"Centre for Healthcare\u2010Associated Infections, Antimicrobial Resistance and Mycoses National Institute for Communicable Diseases, A Division of the National Health Laboratory Service 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