Abstract
BackgroundThe HIV pandemic continues to cause a high burden of morbidity and mortality due to delayed diagnosis. Histoplasmosis is prevalent in Latin America and Colombia, is difficult to diagnose and has a high mortality. Here we determined the clinical characteristics and risk factors of histoplasmosis in people living with HIV (PLWH) in Pereira, Colombia.Materials and methodsThis was a retrospective cross-sectional study (2014–2019) involving two tertiary medical centers in Pereira, Colombia. People hospitalized with HIV were included. Histoplasma antigen detection was performed in urine samples. Probable histoplasmosis was defined according to European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group/National Institute of Allergy and Infectious Diseases Mycoses Study Group criteria.Results172 HIV-infected patients were analyzed. Histoplasmosis was confirmed in 29% (n = 50/172) of patients. The logistic regression analysis showed that the risk factors for histoplasmosis were pancytopenia (OR 4.1, 95% CI 1.6–10.3, P = 0.002), < 50 CD4 + cells/μL (OR 3.1, 95% CI 1.3–7.3, P = 0.006) and Aspartate transaminase (AST) levels > 46 IU/L (OR 3.2, 95% CI 1.3–8, P = 0.010).ConclusionsHistoplasmosis is highly prevalent in hospitalized patients with HIV in Pereira, Colombia. The clinical findings are nonspecific, but there are some clinical abnormalities that can lead to suspicion of the disease, early diagnosis and prompt treatment. Urine antigen detection is useful for diagnosis, but is not widely available. An algorithmic approach is proposed for low-resource clinical settings.
Highlights
The HIV pandemic continues to cause a high burden of morbidity and mortality due to delayed diagnosis
The logistic regression analysis showed that the risk factors for histoplasmosis were pancytopenia, < 50 CD4 + cells/μL and Aspartate transaminase (AST) levels > 46 IU/L
All adult (≥ 18 years old) patients with documented HIV infection were candidates for inclusion in the study, if they were hospitalized for a clinical suspicion of an AIDS-defining disease like histoplasmosis based on clinical manifestations and laboratory findings such as the following: fever and/or weight loss (> 10% of usual body weight), cough, diarrhea, miliary opacities on thorax imaging, pancytopenia, lymphadenopathy, splenomegaly and/or hepatomegaly and abnormal liver function test, ferritin and lactic dehydrogenase (LDH) serum levels
Summary
The HIV pandemic continues to cause a high burden of morbidity and mortality due to delayed diagnosis. Histoplasmosis is prevalent in Latin America and Colombia, is difficult to diagnose and has a high mortality. We determined the clinical characteristics and risk factors of histoplasmosis in people living with HIV (PLWH) in Pereira, Colombia. In Colombia, histoplasmosis is not a mandatory reporting. Hoyos Pulgarin et al AIDS Res Ther (2021) 18:51 entity, so, the burden of the disease is unknown. The disease begins when microconidia or small hyphal elements are inhaled and convert to yeasts in the lungs, or when organisms in previous quiescent foci of infection are reactivated during immunosuppression [1, 2]. H. capsulatum may cause a disseminated and potentially fatal disease in immunosuppressed patients (Progressive Disseminated Histoplasmosis) [1, 3]
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