Coccidioidomycosis in human immunodeficiency virus-infected persons in Arizona, 1994-1997: incidence, risk factors, and prevention

J Infect Dis. 2000 Apr;181(4):1428-34. doi: 10.1086/315401. Epub 2000 Apr 7.

Abstract

From 1 January 1995 through 31 June 1997, 153 cases of coccidioidomycosis in human immunodeficiency virus (HIV)-infected persons were identified in Arizona (incidence, 41/1000 persons living with AIDS). A case-control study was conducted to evaluate risk factors for coccidioidomycosis in HIV-infected persons. A case was defined as laboratory-confirmed, incident coccidioidomycosis in a person infected with HIV for > or =3 months, and each case patient had 3 control patients matched by county, age group, sex, HIV/AIDS status, and CD4 lymphocyte count. Multivariable analysis identified black race and a history of oropharyngeal or esophageal candidiasis to be associated with increased risk of coccidioidomycosis; protease inhibitor therapy was associated with a reduced risk. In persons with previous history of oropharyngeal or esophageal candidiasis, having received an azole drug was associated with a reduced risk (odds ratio, 0.4; 95% confidence interval, 0.2-0.9; P=.04). Physicians may need to consider azole chemoprophylaxis for HIV-infected persons who live in areas of endemicity, have CD4 cell counts <200/microL, are black, or have a history of thrush.

MeSH terms

  • AIDS-Related Opportunistic Infections / epidemiology*
  • AIDS-Related Opportunistic Infections / immunology
  • AIDS-Related Opportunistic Infections / prevention & control
  • Adult
  • African Continental Ancestry Group
  • Arizona / epidemiology
  • CD4 Lymphocyte Count
  • Candidiasis, Oral / complications
  • Case-Control Studies
  • Coccidioidomycosis / epidemiology*
  • Coccidioidomycosis / prevention & control
  • Databases, Factual
  • Esophageal Diseases / complications
  • Esophageal Diseases / microbiology
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Oropharynx / microbiology
  • Retrospective Studies
  • Risk Factors
  • Socioeconomic Factors