Risk factors for disseminated histoplasmosis in a cohort of HIV-infected patients in French Guiana.
Disseminated histoplasmosis is the first AIDS-defining infection in French Guiana. A retrospective cohort study studied predictive factors of disseminated histoplasmosis in HIV-infected patients between 1996 and 2008. Cox proportional hazards models were used. The variables studied were age, sex, last CD4/CD8 count, CD4 nadir, herpes or pneumocystosis, cotrimoxazole and fluconazole use, antiretroviral treatment and the notion of recent initiation of HAART. A total of 1404 patients were followed for 6833 person-years. The variables independently associated with increased incidence of disseminated histoplasmosis were CD4 count<50 per mm3, CD4 count between 50 and 200 per mm3, a CD4 nadir <50 per mm3, CD8 count in the lowest quartile, herpes infection, and recent antiretroviral treatment initiation (less than 6 months). The variables associated with decreased incidence of histoplasmosis were antiretroviral treatment for more than 6 months, fluconazole treatment, and pneumocystosis. There were 13.5% of deaths at 1 month, 17.5% at 3 months, and 22.5% at 6 months after the date of diagnosis of histoplasmosis. The most important predictive factors for death within 6 months of diagnosis were CD4 counts and antiretroviral treatment. The present study did not study environmental/occupational factors but provides predictive factors for disseminated histoplasmosis and its outcome in HIV patients in an Amazonian environment during the HAART era.
Centre d'Investigation Clinique, Epidémiologie Clinique Antilles Guyane (CIC EC CIE802), Centre Hospitalier de Cayenne, Cayenne, French Guiana ; COREVIH Guyane, CH de Cayenne, Cayenne, French Guiana ; Equipe EA 3593 Epidemiologie des Parasitoses et Mycoses Tropicales, Université Antilles Guyane, Campus Saint Denis, Cayenne, French Guiana.
Mathieu
M
Nacher
Centre d'Investigation Clinique, Epidémiologie Clinique Antilles Guyane (CIC EC CIE802), Centre Hospitalier de Cayenne, Cayenne, French Guiana.
Antoine
A
Adenis
Equipe EA 3593 Epidemiologie des Parasitoses et Mycoses Tropicales, Université Antilles Guyane, Campus Saint Denis, Cayenne, French Guiana ; Laboratoire Hospitalo Universitaire de Parasitologie Mycologie, CH de Cayenne, Cayenne, French Guiana.
Denis
D
Blanchet
Service de Médecine, Centre Hospitalier de l'Ouest Guyanais, Saint Laurent du Maroni, French Guiana.
Vincent
V
Vantilcke
Equipe EA 3593 Epidemiologie des Parasitoses et Mycoses Tropicales, Université Antilles Guyane, Campus Saint Denis, Cayenne, French Guiana ; Unité des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, Cayenne, French Guiana.
Magalie
M
Demar
Centre d'Investigation Clinique, Epidémiologie Clinique Antilles Guyane (CIC EC CIE802), Centre Hospitalier de Cayenne, Cayenne, French Guiana.
Célia
C
Basurko
COREVIH Guyane, CH de Cayenne, Cayenne, French Guiana.
Emilie
E
Gaubert-Maréchal
Service Dermatologie, CH de Cayenne, Cayenne, French Guiana.
Julie
J
Dufour
Equipe EA 3593 Epidemiologie des Parasitoses et Mycoses Tropicales, Université Antilles Guyane, Campus Saint Denis, Cayenne, French Guiana ; Laboratoire Hospitalo Universitaire de Parasitologie Mycologie, CH de Cayenne, Cayenne, French Guiana.
Christine
C
Aznar
Equipe EA 3593 Epidemiologie des Parasitoses et Mycoses Tropicales, Université Antilles Guyane, Campus Saint Denis, Cayenne, French Guiana ; Laboratoire Hospitalo Universitaire de Parasitologie Mycologie, CH de Cayenne, Cayenne, French Guiana.
Bernard
B
Carme
Equipe EA 3593 Epidemiologie des Parasitoses et Mycoses Tropicales, Université Antilles Guyane, Campus Saint Denis, Cayenne, French Guiana ; Service Dermatologie, CH de Cayenne, Cayenne, French Guiana.
Pierre
P
Couppié
D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005616:French Guiana / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications*; D006660:Histoplasmosis / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D055815:Young Adult