title: HIV-associated histoplasmosis early mortality and incidence trends: from neglect to priority.
abstract: BACKGROUND
  Histoplasmosis is an endemic fungal infection in French Guiana. It is the most common AIDS-defining illness and the leading cause of AIDS-related deaths. Diagnosis is difficult, but in the past 2 decades, it has improved in this French overseas territory which offers an interesting model of Amazonian pathogen ecology. The objectives of the present study were to describe the temporal trends of incidence and mortality indicators for HIV-associated histoplasmosis in French Guiana.
  
  
  METHODS
  A retrospective study was conducted to describe early mortality rates observed in persons diagnosed with incident cases of HIV-associated Histoplasma capsulatum var. capsulatum histoplasmosis admitted in one of the three main hospitals in French Guiana between 1992 and 2011. Early mortality was defined by death occurring within 30 days after antifungal treatment initiation. Data were collected on standardized case report forms and analysed using standard statistical methods.
  
  
  RESULTS
  There were 124 deaths (45.3%) and 46 early deaths (16.8%) among 274 patients. Three time periods of particular interest were identified: 1992-1997, 1998-2004 and 2005-2011. The two main temporal trends were: the proportion of early deaths among annual incident histoplasmosis cases significantly declined four fold (χ2, p<0.0001) and the number of annual incident histoplasmosis cases increased three fold between 1992-1997 and 1998-2004, and subsequently stabilized.
  
  
  CONCLUSIONS
  From an occasional exotic diagnosis, AIDS-related histoplasmosis became the top AIDS-defining event in French Guiana. This was accompanied by a spectacular decrease of early mortality related to histoplasmosis, consistent with North American reference center mortality rates. The present example testifies that rapid progress could be at reach if awareness increases and leads to clinical and laboratory capacity building in order to diagnose and treat this curable disease.
authors.affiliation: Inserm CIC 1424, Centre d'Investigation Clinique Antilles Guyane, Centre Hospitalier de Cayenne, Cayenne, France; Equipe EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Université des Antilles et de la Guyane, Cayenne, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Adenis
authors.affiliation: Inserm CIC 1424, Centre d'Investigation Clinique Antilles Guyane, Centre Hospitalier de Cayenne, Cayenne, France; Equipe EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Université des Antilles et de la Guyane, Cayenne, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Nacher
authors.affiliation: Inserm CIC 1424, Centre d'Investigation Clinique Antilles Guyane, Centre Hospitalier de Cayenne, Cayenne, France; Equipe EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Université des Antilles et de la Guyane, Cayenne, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Hanf
authors.affiliation: Service de Médecine Interne, Centre Hospitalier de l'Ouest Guyanais, Saint Laurent du Maroni, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Vantilcke
authors.affiliation: Laboratoire de Biologie Médicale, Centre Hospitalier de l'Ouest Guyanais, Saint Laurent du Maroni, France.
authors.forename: Rachida
authors.initials: R
authors.lastname: Boukhari
authors.affiliation: Equipe EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Université des Antilles et de la Guyane, Cayenne, France; Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Centre Hospitalier de Cayenne, Cayenne, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Blachet
authors.affiliation: Equipe EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Université des Antilles et de la Guyane, Cayenne, France; Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Centre Hospitalier de Cayenne, Cayenne, France; Unité des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, Cayenne, France.
authors.forename: Magalie
authors.initials: M
authors.lastname: Demar
authors.affiliation: Equipe EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Université des Antilles et de la Guyane, Cayenne, France; Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Centre Hospitalier de Cayenne, Cayenne, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Aznar
authors.affiliation: Inserm CIC 1424, Centre d'Investigation Clinique Antilles Guyane, Centre Hospitalier de Cayenne, Cayenne, France; Equipe EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Université des Antilles et de la Guyane, Cayenne, France; Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Centre Hospitalier de Cayenne, Cayenne, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Carme
authors.affiliation: Equipe EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Université des Antilles et de la Guyane, Cayenne, France; Service de Dermatologie Vénérologie, Centre Hospitalier de Cayenne, Cayenne, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Couppie
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D005260:Female; D005616:French Guiana / Q000453:epidemiology; D006660:Histoplasmosis / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000935:Antifungal Agents