  
Susceptible HIV patients need histoplasmosis prophylaxis
Last Updated: 2001-04-18 13:16:26 EDT (Reuters Health)
By Will Boggs, MD
WESTPORT, CT (Reuters Health) - HIV patients with low CD4+ counts who live in areas where Histoplasma capsulatum is endemic may benefit from chemoprophylaxis with triazole antifungals, according to a report in the April 15th issue of Clinical Infectious Diseases.
Morbidity and mortality from histoplasmosis have not changed over the years in HIV-infected individuals, the authors explain, though the risk factors contributing to its development in this population have not been identified.
Dr. Rana A. Hajjeh from the Centers for Disease Control and Prevention in Atlanta and colleagues examined the risk factors for histoplasmosis among 344 HIV-infected individuals, 92 of whom developed histoplasmosis.
All but seven of the patients who were diagnosed with histoplasmosis had CD4+ lymphocyte counts below 100 cells/µL, the report indicates. Eleven patients (12%) died within 3 months of their diagnosis.
The only other factor that increased the risk of developing histoplasmosis was having worked with soil contaminated with bird or bat droppings, the authors report.
On the other hand, any antiretroviral therapy, a history of Pneumocystis carinii pneumonia, and treatment with any triazole drug in the 2 months before study entry significantly reduced the likelihood of developing histoplasmosis, the researchers note.
Patients were considerably more likely to have a poor outcome from histoplasmosis if they had another chronic disease, a history of herpes simplex infection, or histoplasmosis-related lesions in the gastrointestinal tract, the results indicate. Trimethoprim-sulfamethoxazole prophylaxis for P. carinii pneumonia, however, substantially reduced the likelihood of a poor outcome.
"Although we did not present data on incidence of disease in this article, we believe that the incidence has declined over the last few years among persons with AIDS," Dr. Hajjeh told Reuters Health. The mortality and morbidity in patients presenting with severe manifestations have not changed much, "probably because many of the patients who are developing histoplasmosis are those who have not had adequate access to medical care."
"In areas endemic for histoplasmosis, physicians need to consider chemoprophylaxis for histoplasmosis in persons with AIDS," Dr. Hajjeh concluded. Particular attention is need for "those with occupational histories involving frequent exposure to soil, and who are severely immunocompromised (CD4+ <100), and are not receiving antiretroviral therapy, or just started receiving such therapy."
Clin Infect Dis 2001;32:1215-1220.
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