Abstract
Background: In French Guiana, a recent study has shown that a major part of the histoplasmosis incidence temporal fluctuations could be explained by climatic factors and thus postulated that disseminated histoplasmosis cases could be in a large proportion due to new infections. The description of the seasonal pattern of histoplasmosis could potentially help to test this new hypothesis. Patients and methods: A study using prospective data from the French Hospital Database for HIV was conducted in order to determine seasonal variations of the incidence of first cases of disseminated histoplasmosis in HIV persons in Cayenne, French Guiana. Single failure Cox proportional hazards models were used. Results: After adjusting for CD4 counts and antiretroviral treatment, the incidence of disseminated histoplasmosis was significantly higher during the Short Wet Season–Long Dry Season than during the Short Dry Season–Long Wet Season (Adjusted Hazard ratio 1.7 (1.1-2.5), P= 0.01). Conclusion: This result gives both valuable epidemiologic information to clinicians and a supplementary argument in favour of the hypothesis that an important proportion of cases were due to recent exposure. Therefore, the use of a primary prophylaxis must be discussed in French Guiana.
Highlights
French Guiana is the French overseas territory where the HIV epidemic is most preoccupying
A recent study has shown that a major part of the histoplasmosis incidence temporal fluctuations could be explained by climatic factors and postulated that disseminated histoplasmosis cases could be in a large proportion due to new infections [4]
A total of 2275 subjects were followed for a total of 9202 years
Summary
French Guiana is the French overseas territory where the HIV epidemic is most preoccupying. Disseminated histoplasmosis is one of the most frequent opportunistic infections due to HIV in French Guiana, and is the first AIDS defining illness with an incidence rate of 1.5 per 100 person-years [1]. Disseminated histoplasmosis is the first causes of AIDS-related death in French Guiana [2]. It generally occurs when a patient’s CD4+ T lymphocyte count is less than 100 cells/mm. In French Guiana, a recent study has shown that a major part of the histoplasmosis incidence temporal fluctuations could be explained by climatic factors and postulated that disseminated histoplasmosis cases could be in a large proportion due to new infections. The description of the seasonal pattern of histoplasmosis could potentially help to test this new hypothesis
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