title: Increased incidence of disseminated histoplasmosis following highly active antiretroviral therapy initiation.
abstract: To determine whether the initiation of highly active antiretroviral therapy (HAART) had any influence on the incidence of disseminated histoplasmosis, a retrospective cohort study was performed on 1551 patients followed for up to 12 years. After controlling for CD4 counts, age, and sex, patients taking HAART for 2 months or less were more likely to develop disseminated histoplasmosis than untreated patients (respectively, hazard ratio, 3.7 [95% confidence interval, 1.57-8.7]; P = 0.003). In contrast, after 6 months of HAART, treated patients were less likely to develop disseminated histoplasmosis than untreated patients (hazard ratio, 0.6 [95% confidence interval, 0.37-0.98], P = 0.04). This increased incidence suggests that the initiation of HAART and the subsequent immune reconstitution may reveal undiagnosed latent disseminated histoplasmosis.
authors.affiliation: CISIH, Cayenne General Hospital, French Guiana. m_nacher@lycos.com
authors.forename: Mathieu
authors.initials: M
authors.lastname: Nacher
authors.forename: Frédérique
authors.initials: F
authors.lastname: Sarazin
authors.forename: Myriam
authors.initials: M
authors.lastname: El Guedj
authors.forename: Tania
authors.initials: T
authors.lastname: Vaz
authors.forename: Fernand
authors.initials: F
authors.lastname: Alvarez
authors.forename: Valery
authors.initials: V
authors.lastname: Nasser
authors.forename: Andry
authors.initials: A
authors.lastname: Randrianjohany
authors.forename: Christine
authors.initials: C
authors.lastname: Aznar
authors.forename: Bernard
authors.initials: B
authors.lastname: Carme
authors.forename: Pierre
authors.initials: P
authors.lastname: Couppié
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006660:Histoplasmosis / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D012189:Retrospective Studies; D013223:Statistics as Topic; D013997:Time Factors