title: [Efficacy of the treatment and secondary antifungal prophylaxis in AIDS-related histoplasmosis. Experience at the Francisco J. Muñiz Infectious Diseases Hospital in Buenos Aires].
abstract: BACKGROUND
  Classic histoplasmosis is a systemic endemic mycosis due to Histoplasma capsulatum var. capsulatum. A significant reduction in the morbidity and mortality of AIDS-related histoplasmosis has been observed since the introduction of highly active antiretroviral therapy (HAART) and secondary antifungal prophylaxis.
  
  
  OBJECTIVE
  The aim of this study was to determine the current state of prognosis and treatment response of HIV-positive patients with histoplasmosis in the Francisco J. Muñiz Infectious Diseases Hospital in Buenos Aires City.
  
  
  METHODS
  A retrospective study was conducted using the demographic, clinical, immunological and treatment data of 80 patients suffering from AIDS-related histoplasmosis.
  
  
  RESULTS
  Of the 80 cases studied 65 were male, the median age was 36 years, with 73.7% of the patients being drug addicts, 82.5% of the patients was not receiving HAART at diagnosis, and 58.7% of the cases had less than 50 CD4+ cells/μl at the beginning of the treatment. The initial phase of treatment consisted of intravenous amphotericin B and/or oral itraconazole for 3 months, with 78.7% of the cases showing a good clinical response. Only 26/63 patients who were discharged from hospital continued with the follow-up of the HAART, secondary prophylaxis with itraconazole or amphotericin B. Secondary prophylaxis was stopped after more than one year of HAART if the patients were asymptomatic, had two CD4+ cell counts greater than 150cells/μl, and undetectable viral loads. No relapses were observed during a two-year follow up after prophylaxis was stopped.
  
  
  CONCLUSIONS
  The treatment of histoplasmosis in HIV-positive patients was effective in 78.8% of the cases. The combination of HAART and secondary antifungal prophylaxis is safe, well tolerated, and effective. The low adherence of patients to HAART and the lack of laboratory kits for rapid histoplasmosis diagnosis should be addressed in the future. The usefulness of primary antifungal prophylaxis for cryptococcosis and histoplasmosis HIV-positive patients should be studied.
authors.affiliation: Unidad de Micología, Hospital de Infecciosas Francisco J. Muñiz, Ciudad Autónoma de Buenos Aires, Argentina. Electronic address: ricnegroni@hotmail.com.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Negroni
authors.affiliation: Unidad de Micología, Hospital de Infecciosas Francisco J. Muñiz, Ciudad Autónoma de Buenos Aires, Argentina.
authors.forename: Fernando
authors.initials: F
authors.lastname: Messina
authors.affiliation: Unidad de Micología, Hospital de Infecciosas Francisco J. Muñiz, Ciudad Autónoma de Buenos Aires, Argentina.
authors.forename: Alicia
authors.initials: A
authors.lastname: Arechavala
authors.affiliation: Unidad de Micología, Hospital de Infecciosas Francisco J. Muñiz, Ciudad Autónoma de Buenos Aires, Argentina.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Santiso
authors.affiliation: Unidad de Micología, Hospital de Infecciosas Francisco J. Muñiz, Ciudad Autónoma de Buenos Aires, Argentina.
authors.forename: Mario
authors.initials: M
authors.lastname: Bianchi
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control; D000328:Adult; D019380:Anti-HIV Agents / Q000493:pharmacokinetics / Q000627:therapeutic use; D000935:Antifungal Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001118:Argentina / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D004347:Drug Interactions; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy; D006658:Histoplasma / Q000187:drug effects; D006660:Histoplasmosis / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control; D006782:Hospitals, Special; D006801:Humans; D055552:Infectious Disease Medicine; D017964:Itraconazole / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000150:complications; D019562:Viral Load; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D000935:Antifungal Agents; D017964:Itraconazole
keywords: Amphotericin B; Anfotericina B; Histoplasmosis; Itraconazol; Itraconazole; Profilaxis secundaria; Secondary prophylaxis; Tratamiento; Treatment