# Systematic Review of Cryptococcus neoformans Seroprevalence, Antifungal Susceptibility, and Pathogenesis in Patients With HIV/AIDS on Combination Antiretroviral Therapy in Abuja, Nigeria

## TL;DR

This study reviews the prevalence and impact of Cryptococcus neoformans infections in HIV/AIDS patients in Abuja, Nigeria, to improve diagnosis and treatment strategies.

## Contribution

The study establishes a seroprevalence baseline for cryptococcosis in Abuja and identifies virulence markers to guide public health interventions.

## Key findings

- Cryptococcus neoformans remains a significant cause of mortality in HIV/AIDS patients despite ART advancements.
- The study identifies virulence-associated genetic markers and recommends integrating cryptococcal screening into HIV care.
- Findings support improved screening protocols and treatment regimens to reduce CM-related deaths.

## Abstract

For individuals living with HIV/AIDS in low-resource settings such as Sub-Saharan African countries, including Nigeria, cryptococcal meningitis (CM) is a significant contributor to both mortality and morbidity. Despite advancements in antiretroviral therapy (ART), which have markedly transformed the treatment and management of HIV, CM remains a considerable challenge. It primarily arises from delays in diagnosis, limited access to antifungal treatments, and a lack of healthcare resources and infrastructure. With the historical correlation between the rising prevalence of HIV/AIDS and the increased incidence of Cryptococcus neoformans infections, understanding the genetic diversity and virulence factors of these pathogens is essential. Sub-Saharan Africa continues to face elevated rates of CM-related deaths. This underscores the urgent need for effective intervention strategies. The objective of this study is to determine the seroprevalence of the Cryptococcus species within the Abuja population, evaluate the susceptibility of circulating C. neoformans clinical isolates to the antifungal medications widely used for treating cryptococcosis, and assess the correlation between the levels of micronutrients and the progression of Cryptococcus infection in individuals with HIV/AIDS. To this end, we conducted an extensive literature search across various online databases, including Embase, PubMed, Scopus, Web of Science, and Google Scholar. The studies analyzed included those with a crossover design, randomized controlled trials (RCTs), systematic reviews, meta-analyses, and prospective cohort studies focused on palliative care in heart failure patients. Fifteen studies were included in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The study findings support public health initiatives by informing screening protocols, enhancing treatment regimens, and improving overall patient care outcomes. By advancing the understanding of the pathogenesis and transmission of C. neoformans, this study contributes to global efforts aimed at reducing CM-associated morbidity and mortality rates among patients with HIV. In this context, it establishes a seroprevalence baseline for cryptococcosis in Abuja, Nigeria, identifies virulence-associated genetic markers, and recommends integrating cryptococcal screening into HIV care and management.