title: Histoplasmosis in HIV-infected patients in a southern regional medical center: poor prognosis in the era of highly active antiretroviral therapy.
abstract: Histoplasmosis is an important opportunistic infection among HIV-infected patients in endemic areas, and clinical outcomes are often poor. Additional data on factors associated with outcomes are needed to better identify patients who may require aggressive care. Using a cohort of 46 HIV-infected patients with histoplasmosis from an underserved city endemic for histoplasmosis, we explored epidemiology, outcomes, and prognostic factors. Histoplasmosis was the 1st recognized manifestation of HIV infection in 12 (26.1%) of 46 patients. Death occurred in 18 (39%) patients within 3 months of diagnosis of histoplasmosis. Fungemia (odds ratio [OR], 12.1; 95% confidence interval [CI], 1.9-76; P=0.008), renal insufficiency (OR, 11.3; 95% CI, 1.7-77.2; P=0.01), and age (OR, 0.9; 95% CI, 0.8-0.98; P=0.02) were independent predictors of poor prognosis. Histoplasmosis in HIV patients is associated with poor outcomes. Identification of prognostic factors may be helpful in identifying patients who require more aggressive care.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294-0006, USA. jbaddley@uab.edu
authors.forename: John W
authors.initials: JW
authors.lastname: Baddley
authors.forename: Ishwara R
authors.initials: IR
authors.lastname: Sankara
authors.forename: J Martin
authors.initials: JM
authors.lastname: Rodriquez
authors.forename: Peter G
authors.initials: PG
authors.lastname: Pappas
authors.forename: Wickliffe J
authors.initials: WJ
authors.lastname: Many
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality; D000328:Adult; D000367:Age Factors; D000407:Alabama / Q000453:epidemiology; D023241:Antiretroviral Therapy, Highly Active; D019353:Endemic Diseases; D005260:Female; D016469:Fungemia; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000821:virology; D006658:Histoplasma / Q000302:isolation & purification; D006660:Histoplasmosis / Q000150:complications / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D051437:Renal Insufficiency; D014505:Urban Population