930. Clinical Presentation, Treatment, and Outcomes for People with HIV with Histoplasmosis in Memphis, Tennessee

Abstract

BackgroundThere is limited data on the presentation, treatment, and outcomes in persons with HIV (PWH) with histoplasmosis in the era of modern antiretroviral therapy (ART). We conducted a retrospective review of PWH presenting with histoplasmosis in Memphis, TN.MethodsAll cases of PWH with Histoplasmosis diagnosed or treated between January 1, 2013 and December 31, 2019 at Regional One Health were identified. Cases captured in obsolete and inaccessible EMRs were excluded. Baseline demographics, presentation data, treatment, duration of treatment, and outcomes were abstracted by chart review. A pooled T-test was performed to compare outcomes between those receiving short (≤ 7 days) and longer courses (> 7 days) of amphotericin.ResultsThirty-four participants were included, of which 30 (88%) were diagnosed in the hosptial. The mean age of participants was 41 years, 25 (73.5%) were male, and 31 (91%) were black. Median CD4 cell count and HIV viral load were 15 cells/µL, and 415,220 copies/mL, respectively. Median length of time between HIV diagnosis and presentation with histoplasmosis was 3.25 years. Common presenting symptoms included weight loss (21, 61.76%), gastrointestinal symptoms (22, 64.76%), and respiratory symptoms (19, 55.88%). Twenty-seven (79.41%) of participants met SIRS criteria on presentation, two required intensive care, and two participants met HLH criteria. The time between presentation and initiation of appropriate anti-fungal treatment was a median of 1.5 days. The majority of participants received amphotericin B as initial treatment (67.65%, N = 23). Twenty-five (60%) participants ultimately received amphotericin, 14 of whom received it for 7 days or less. The median duration of hospitalization was observed to be shorter among the group receiving 7 days or less of amphotericin (7 vs. 10.5 days), although not statistically significant. Overall 30 day mortality was 0%.ConclusionThis study describes a population of PWH presenting with histoplasmosis in Memphis, TN. Appropriate antifungal therapy was started quickly and patients did well whether they were treated with a short course (7 days or less) or long course of amphotericin. Further research on the duration of amphotericin B in this population is warranted.Disclosures All Authors: No reported disclosures