Coccidioidomycosis in patients with HIV-1 infection in the era of potent antiretroviral therapy.
BACKGROUND
Coccidioidomycosis is a common opportunistic infection in human immunodeficiency virus type 1 (HIV-1)-infected individuals living in regions where coccidioidomycosis is endemic. However, there have been no studies on its incidence or clinical expression during the era of potent antiretroviral therapy.


METHODS
Clinical data were abstracted from the records of all HIV-1-infected patients attending a single clinic in a region where coccidioidomycosis is endemic from January 2003 through May 2008. Additional follow-up was performed through May 2009 for individuals with active coccidioidomycosis. A case-control study was performed that compared all individuals who attended the clinic with individuals who received a diagnosis of coccidioidomycosis.


RESULTS
Among 257 HIV-1-infected patients seen over a 64-month period, 29 cases (11.3%) of coccidioidomycosis were identified. Twelve patients (4.7%) received a diagnosis of coccidioidomycosis during the study period (annual incidence, 0.9%). Patients with less severe coccidioidomycosis were significantly more likely to have an undetectable HIV RNA level and to be receiving potent antiretroviral therapy than were those with more severe disease (for both, P< .01). Five patients with coccidioidomycosis received no antifungal therapy, and 11 others had antifungal therapy discontinued. All were healthy during follow-up. Patients with coccidioidomycosis had significantly lower CD4 T lymphocyte counts than did control subjects (mean +/- standard deviation, 285 +/- 42 cells/microL vs 477 +/- 21 cells/microL; P= .003).


CONCLUSIONS
The incidence of symptomatic coccidioidomycosis in the era of potent antiretroviral therapy has decreased, and its clinical expression is less severe than it was before the potent antiretroviral therapy era. Severity of coccidioidomycosis was inversely associated with control of HIV-1 infection.
Masannat
Fares Y
FY
Division of Infectious Diseases, Department of Medicine, and Valley Fever Center for Excellence, University of Arizona, and Southern Arizona Veterans Affairs Health Care System, Tucson, USA.
Ampel
Neil M
NM
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use; D001130:Arizona / Q000453:epidemiology; D016022:Case-Control Studies; D003045:Coccidioides / Q000302:isolation & purification; D003047:Coccidioidomycosis / Q000188:drug therapy / Q000453:epidemiology / Q000821:virology*; D019353:Endemic Diseases; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged
D044966:Anti-Retroviral Agents; D000935:Antifungal Agents