title: Disseminated histoplasmosis in HIV-infected patients: determinants of relapse and mortality in a north-eastern area of Brazil.
abstract: Many relapses and deaths resulting from disseminated histoplasmosis (DH) in acquired immunodeficiency syndrome (AIDS) patients have been observed in an endemic area in north-eastern Brazil. The objective of this study was to evaluate the risk factors associated with the clinical outcomes of DH/AIDS coinfection in patients from the state of Ceará, Brazil. A retrospective cohort of AIDS patients, after their hospital discharge due to first DH episode in the period 2002-2008, was followed until December 31, 2010, to investigate the factors associated with relapse and mortality. A total of 145 patients were evaluated in the study. Thirty patients (23.3%) relapsed and the overall mortality was 30.2%. The following variables were significantly (P < 0.05) associated with relapse and overall mortality (univariate analysis): non-adherence to highly active antiretroviral therapy (HAART), irregular use of an antifungal, non-recovery of the CD4+ count and having AIDS before DH; histoplasmosis relapse was also significantly associated with mortality. In the multivariate analysis, non-adherence to HAART was the independent risk factor that was associated with both relapse (Adj OR = 6.28) and overall mortality (Adj OR = 8.03); efavirenz usage was discovered to be significant only for the overall mortality rate (Adj OR = 4.50). Adherence to HAART was the most important variable that influenced the outcomes in this specific population.
authors.affiliation: Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil; Hospital São José of Infectious Disease, Fortaleza, CE, Brazil.
authors.forename: Lisandra Serra
authors.initials: LS
authors.lastname: Damasceno
authors.forename: Alberto Novaes
authors.initials: AN
authors.lastname: Ramos
authors.forename: Carlos Henrique
authors.initials: CH
authors.lastname: Alencar
authors.forename: Maria Vânia Freitas
authors.initials: MV
authors.lastname: Gonçalves
authors.forename: Jacó Ricarte Lima
authors.initials: JR
authors.lastname: de Mesquita
authors.forename: Anne Taumaturgo Dias
authors.initials: AT
authors.lastname: Soares
authors.forename: Anna Gisele Nunes
authors.initials: AG
authors.lastname: Coutinho
authors.forename: Carolina Cavalcante
authors.initials: CC
authors.lastname: Dantas
authors.forename: Terezinha do Menino Jesus Silva
authors.initials: Tdo M
authors.lastname: Leitão
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality*; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D001938:Brazil / Q000453:epidemiology; D060085:Coinfection / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D006660:Histoplasmosis / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality* / Q000821:virology*; D006801:Humans; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000935:Antifungal Agents
keywords: Disseminated histoplasmosis; HIV; mortality; relapse