title: Coccidioidomycosis in human immunodeficiency virus-infected persons in Arizona, 1994-1997: incidence, risk factors, and prevention.
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.
authors.affiliation: Epidemic Intelligence Service, Epidemiology Program Office, and Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30307, USA.
authors.forename: C W
authors.initials: CW
authors.lastname: Woods
authors.forename: C
authors.initials: C
authors.lastname: McRill
authors.forename: B D
authors.initials: BD
authors.lastname: Plikaytis
authors.forename: N E
authors.initials: NE
authors.lastname: Rosenstein
authors.forename: D
authors.initials: D
authors.lastname: Mosley
authors.forename: D
authors.initials: D
authors.lastname: Boyd
authors.forename: B
authors.initials: B
authors.lastname: England
authors.forename: B A
authors.initials: BA
authors.lastname: Perkins
authors.forename: N M
authors.initials: NM
authors.lastname: Ampel
authors.forename: R A
authors.initials: RA
authors.lastname: Hajjeh
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control; D000328:Adult; D001130:Arizona / Q000453:epidemiology; D044383:Black People; D018791:CD4 Lymphocyte Count; D002180:Candidiasis, Oral / Q000150:complications; D016022:Case-Control Studies; D003047:Coccidioidomycosis / Q000453:epidemiology* / Q000517:prevention & control; D016208:Databases, Factual; D004935:Esophageal Diseases / Q000150:complications / Q000382:microbiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009960:Oropharynx / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D001741:Black or African American