Histoplasmosis in HIV-infected patients in a southern regional medical center: poor prognosis in the era of highly active antiretroviral therapy

Diagn Microbiol Infect Dis. 2008 Oct;62(2):151-6. doi: 10.1016/j.diagmicrobio.2008.05.006. Epub 2008 Jul 1.

Abstract

Histoplasmosis is an important opportunistic infection among HIV-infected patients in endemic areas, and clinical outcomes are often poor. Additional data on factors associated with outcomes are needed to better identify patients who may require aggressive care. Using a cohort of 46 HIV-infected patients with histoplasmosis from an underserved city endemic for histoplasmosis, we explored epidemiology, outcomes, and prognostic factors. Histoplasmosis was the 1st recognized manifestation of HIV infection in 12 (26.1%) of 46 patients. Death occurred in 18 (39%) patients within 3 months of diagnosis of histoplasmosis. Fungemia (odds ratio [OR], 12.1; 95% confidence interval [CI], 1.9-76; P=0.008), renal insufficiency (OR, 11.3; 95% CI, 1.7-77.2; P=0.01), and age (OR, 0.9; 95% CI, 0.8-0.98; P=0.02) were independent predictors of poor prognosis. Histoplasmosis in HIV patients is associated with poor outcomes. Identification of prognostic factors may be helpful in identifying patients who require more aggressive care.

MeSH terms

  • AIDS-Related Opportunistic Infections* / diagnosis
  • AIDS-Related Opportunistic Infections* / microbiology
  • AIDS-Related Opportunistic Infections* / mortality
  • Adult
  • Age Factors
  • Alabama / epidemiology
  • Antiretroviral Therapy, Highly Active*
  • Endemic Diseases*
  • Female
  • Fungemia
  • HIV Infections* / complications
  • HIV Infections* / drug therapy
  • HIV Infections* / virology
  • Histoplasma* / isolation & purification
  • Histoplasmosis* / complications
  • Histoplasmosis* / diagnosis
  • Histoplasmosis* / microbiology
  • Histoplasmosis* / mortality
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Renal Insufficiency
  • Urban Population