Multicenter case-control study of risk factors for histoplasmosis in human immunodeficiency virus-infected persons.
We conducted a multicenter case-control study to identify risk factors for histoplasmosis among persons with acquired immunodeficiency syndrome (AIDS) and to evaluate predictors of a poor outcome (defined as death or admission to the intensive care unit). Patients with histoplasmosis were each matched by age, sex, and CD4 lymphocyte count to 3 controls. From 1996 through 1999, 92 case patients and 252 controls were enrolled. Of the case patients, 81 (89%) were men, 50 (55%) were black, 78 (85%) had a CD4 lymphocyte count of <100 cells/microL, 80 (87%) were hospitalized, and 11 (12%) died. Multivariable analysis found that receipt of antiretroviral therapy and of triazole drugs were independently associated with a decreased risk of histoplasmosis. Chronic medical conditions and a history of infections with herpes simplex virus were associated with poor outcome. Triazoles should be considered for chemoprophylaxis for persons with AIDS, especially those who take part in high-risk activities that involve frequent exposure to soil, who have CD4 lymphocyte counts of <100 cells/microL, and who live in areas where histoplasmosis is endemic.
Hajjeh
R A
RA
Mycotic Diseases Branch, Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. rfh5@cdc.gov
Pappas
P G
PG
Henderson
H
H
Lancaster
D
D
Bamberger
D M
DM
Skahan
K J
KJ
Phelan
M A
MA
Cloud
G
G
Holloway
M
M
Kauffman
C A
CA
Wheat
L J
LJ
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000503:physiopathology / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D000818:Animals; D016022:Case-Control Studies; D005260:Female; D006660:Histoplasmosis / Q000188:drug therapy / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome