2014
DOI: 10.1097/md.0000000000000016
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Histoplasmosis in Patients With Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS)

Abstract: Although discontinuation of suppressive antifungal therapy for acquired immunodeficiency syndrome (AIDS)-associated histoplasmosis is accepted for patients with immunologic recovery, there have been no published studies of this approach in clinical practice, and minimal characterization of individuals who relapse with this disease. We performed a multicenter retrospective cohort study to determine the outcome in AIDS patients following discontinuation of suppressive antifungal therapy for histoplasmosis.Ninety… Show more

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Cited by 64 publications
(56 citation statements)
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“…We advocate physicians considering disseminated histoplasmosis in patients with immune suppression, regardless of the location of the hospital to which the patient presents although the weight which one considers progressive disseminated histoplasmosis might vary widely depending on the patient’s location. Currently, Histoplasma antigen testing is not available in many areas not previously thought to be endemic, and this may limit one’s ability to diagnose the condition properly as it is currently the most sensitive method of diagnosis 32,71,110 . We look forward to the day when we no longer hear a presentation that includes, “well, they haven’t been to the Ohio River Valley so it can’t be histoplasmosis” from trainees.…”
Section: Resultsmentioning
confidence: 99%
See 1 more Smart Citation
“…We advocate physicians considering disseminated histoplasmosis in patients with immune suppression, regardless of the location of the hospital to which the patient presents although the weight which one considers progressive disseminated histoplasmosis might vary widely depending on the patient’s location. Currently, Histoplasma antigen testing is not available in many areas not previously thought to be endemic, and this may limit one’s ability to diagnose the condition properly as it is currently the most sensitive method of diagnosis 32,71,110 . We look forward to the day when we no longer hear a presentation that includes, “well, they haven’t been to the Ohio River Valley so it can’t be histoplasmosis” from trainees.…”
Section: Resultsmentioning
confidence: 99%
“…The idea of prevention is supported by a 2001 case-control study in which patients were matched for CD4 count among other factors – patients on ART had less risk all for developing disseminated histoplasmosis, even at low CD4 counts 31 . Interestingly, there have been reports of otherwise untreated histoplasmosis in persons with AIDS improving with ART alone 32 . In many high-income countries guidelines recommend that all HIV-infected persons are started on ART regardless of CD4 count 33 , and so advanced immune suppression related to HIV infection and opportunistic infections such as histoplasmosis are less frequent in these countries.…”
Section: Global Histoplasmosis and The Advent Of Aidsmentioning
confidence: 99%
“…Antigen levels, particularly in serum, have been shown to decline on effective treatment and to increase with treatment failure, providing a useful marker of treatment response. Data for monitoring of antigenemia and antigenuria have been most rigorous among HIV/AIDS patients; in this population, antigen levels in urine and serum of Ͻ2 ng/ml have been proposed as one of the requirements for cure and antifungal discontinuation (20).…”
Section: Antigen Detectionmentioning
confidence: 99%
“…The incidence of HIV/AIDS and histoplasmosis, according to the literature is between 1.4% and 85% [1,16,18]. In our country, as well as throughout the world, the frequency of mucosal manifestations in AIDS patients is not known, due to the fact that only sporadic cases have been reported.…”
Section: Discussionmentioning
confidence: 99%