title: The burden of mucormycosis in HIV-infected patients: A systematic review.
abstract: Mucormycosis is an invasive fungal infection afflicting immunocompromised patients, causing a significant degree of morbidity and mortality. The purpose of the study was to provide a comprehensive analysis describing the epidemiology and outcome of mucormycosis in the scenario of HIV infection.
  
  
  
  We systematically searched PubMed for reports about mucormycosis associated with HIV. Eligible studies describe the predisposing factor, clinical form, treatment, and survival outcome.
  
  
  
  We included 61 articles from 212 reviewed abstracts, corresponding to 67 cases. Patients were mostly men (68.2%) with a median CD4(+) count of 47 [IQR 17-100] cells/mm(3). Intravenous drug use (50%), neutropenia (29.7%) and corticosteroid use (25%) were the predominant associated factors. The main clinical forms were disseminated (20.9%), renal (19.4%), and rhino-cerebral (17.9%). Rhizopus (45.5%) and Lichtheimia spp (30.3%) were the main fungal isolates. Treatment consisted of antifungal therapy and surgery in 38.8%. Overall mortality rate was 52.2%, and varied with the site of infection: 92.9% for disseminated disease, 62.5% for cerebral disease, 60% for pulmonary infection, and 36.4% for cutaneous infection. Survival was worse for those who did not initiate antifungals (p = .04), who were antiretroviral naïve (p = .01), who were admitted to ICU (p = .003) or had disseminated disease (p = .007).
  
  
  
  Mucormycosis is a life-threatening infection in HIV patients and clinician should be aware of this co-infection in the differential diagnosis of HIV opportunistic infections.
authors.affiliation: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil; Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique. Electronic address: jose.moreira@ini.fiocruz.br.
authors.forename: José
authors.initials: J
authors.lastname: Moreira
authors.affiliation: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.
authors.forename: Andrea
authors.initials: A
authors.lastname: Varon
authors.affiliation: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.
authors.forename: Maria Clara
authors.initials: MC
authors.lastname: Galhardo
authors.affiliation: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.
authors.forename: Fabio
authors.initials: F
authors.lastname: Santos
authors.affiliation: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Lyra
authors.affiliation: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Castro
authors.affiliation: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.
authors.forename: Raquel
authors.initials: R
authors.lastname: Oliveira
authors.affiliation: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil; Unigranrio, Infectious Disease Department, Rio de Janeiro, Brazil; Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil.
authors.forename: Cristiane C
authors.initials: CC
authors.lastname: Lamas
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D060085:Coinfection / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality / Q000821:virology; D017281:Cost of Illness; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000821:virology; D006801:Humans; D016867:Immunocompromised Host / Q000276:immunology; D008171:Lung Diseases / Q000150:complications / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009091:Mucormycosis / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D009503:Neutropenia / Q000150:complications / Q000382:microbiology / Q000821:virology; D012233:Rhizopus / Q000302:isolation & purification; D012307:Risk Factors
chemical_list: D000935:Antifungal Agents
keywords: AIDS; Dissemination; HIV; Mortality; Mucormycosis