title: HIV-associated histoplasmosis in a nonendemic area of the United States during the HAART era: role of migration from endemic areas and lack of antiretroviral therapy.
abstract: Histoplasmosis is known to be an AIDS-associated infection, with scattered areas of endemicity throughout the world. Although the Atlanta, GA, metropolitan area is not a highly endemic area, a significant number of cases have been noted at our institution in recent years. Cases of histoplasmosis over a 4-year period were reviewed. All 27 patients (100%) were HIV infected. Thirty percent of patients with histoplasmosis were from Latin American countries. Patients from Latin America were younger than patients from the United States, tended to be more likely to have proven disease, and were exclusively male. Patients with proven disease had significantly higher urine histoplasma antigen levels, lower platelets counts, and lower neutrophil counts than patients with probable disease. The majority of patients survived after treatment with antifungals and initiation of antiretroviral therapy. Histoplasmosis is thus an important consideration in the workup of patients with advanced HIV in nonendemic areas of the United States.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine and Grady Health System, Atlanta, GA 30308, USA. aande2@emory.edu
authors.forename: Albert M
authors.initials: AM
authors.lastname: Anderson
authors.forename: Aneesh K
authors.initials: AK
authors.lastname: Mehta
authors.forename: Yun F
authors.initials: YF
authors.lastname: Wang
authors.lastname: Jing Qian
authors.forename: Kirk
authors.initials: K
authors.lastname: Easley
authors.forename: Minh Ly T
authors.initials: ML
authors.lastname: Nguyen
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000208:ethnology / Q000517:prevention & control; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D004641:Emigration and Immigration; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006660:Histoplasmosis / Q000453:epidemiology* / Q000208:ethnology / Q000517:prevention & control; D006801:Humans; D007843:Latin America / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology