Coccidioidomycosis in human immunodeficiency virus-infected persons in Arizona, 1994-1997: incidence, risk factors, and prevention.
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.
Woods
C W
CW
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.
McRill
C
C
Plikaytis
B D
BD
Rosenstein
N E
NE
Mosley
D
D
Boyd
D
D
England
B
B
Perkins
B A
BA
Ampel
N M
NM
Hajjeh
R A
RA
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