Disseminated histoplasmosis in HIV-infected patients in South America: a neglected killer continues on its rampage
| Autor: | Mathieu Nacher, Magalie Demar, Emilie Gaubert-Marechal, Christine Aznar, Antoine Adenis, Vincent Vantilcke, Denis Blanchet, J. Dufour, Bernard Carme, Pierre Couppié, Célia Basurko |
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| Rok vydání: | 2014 |
| Předmět: |
Adult
Male medicine.medical_specialty lcsh:Arctic medicine. Tropical medicine Adolescent lcsh:RC955-962 HIV Infections Histoplasmosis Cohort Studies Young Adult Risk Factors Internal medicine Epidemiology Pneumocystosis Humans Medicine Aged Retrospective Studies business.industry lcsh:Public aspects of medicine Incidence (epidemiology) Public Health Environmental and Occupational Health lcsh:RA1-1270 Retrospective cohort study Middle Aged medicine.disease Survival Analysis French Guiana Infectious Diseases Cohort Immunology Female business Fluconazole Research Article Cohort study medicine.drug |
| Zdroj: | PLoS Neglected Tropical Diseases PLoS Neglected Tropical Diseases, Vol 8, Iss 1, p e2638 (2014) |
| ISSN: | 1935-2735 |
| DOI: | 10.1371/journal.pntd.0002638 |
| Popis: | 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 Author Summary Disseminated histoplasmosis is the first AIDS-related disease in French Guiana, and probably in the Amazonian area. In order to determine the factors that are associated with histoplasmosis, a retrospective looked at a cohort of HIV-infected patients between 1996 and 2008. Multiple models were used to study the relation of age, sex, last CD4/CD8 count, CD4 nadir, herpes or pneumocystosis, cotrimoxazole and fluconazole use, antiretroviral treatment and the notion of recent initiation of antiretroviral treatment with the occurrence of disseminated histoplasmosis. A total of 1404 patients were followed for 6833 person-years. The variables independently associated with the incidence of disseminated histoplasmosis were low CD4 counts, the lowest CD4 counts were most at risk; Patients with the lowest CD8 counts were also at increased risk; Antiretroviral treatment was generally associated with lower histoplasmosis incidence, but for the first 6 months following antiretroviral treatment initiation there was a transient period of increased risk of diagnosing histoplasmosis; Herpes was also associated with more histoplasmosis; Pneumocystosis and Fluconazole treatment were negatively associated with histoplasmosis. Of 156 patients with histoplasmosis, 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 low CD4 counts and no 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. These results are useful to guide clinicians working in an area where this diagnosis is often overlooked. |
| Databáze: | OpenAIRE |
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