A retrospective analytical study about the efficacy of treatment and secondary antifungal prophylaxis of histoplasmosis in AIDS patients is presented. Seventy-seven medical records were studied of which fifty patients were male. The median age of the cases was 44 years (range from 24 to 75). In 17 cases (19.5%) the diagnosis of HIV infection and histoplasmosis were simultaneously obtained. Only 8 out of 60 cases (13.8%) with positive HIV serology were under antiretroviral treatments. The median T CD4+cell count of 77 patients was 54/µl (range 0-196). Seventy-six cases presented a subacute disseminated histoplasmosis with involvement of several organs and one was diagnosed as a symptomatic primary infection with bilateral severe pneumonia. The diagnosis of histoplasmosis was confirmed by the isolation of Histoplasma capsulatum in cultures and/or by the visualization of typical yeast-like elements in microscope biopsy studies or cytodiagnosis of lesions in 66 cases and by skin and serology tests with histoplasmin in the patient with a symptomatic primary infection. The initial treatment with amphotericin B or itraconazole was effective in 84.4% of cases. 64% of patients discharged after ending the initial treatment continued their follow-up in our Unit. But only 22 cases (28%) completed the control and achieved the necessary conditions to discontinue the antifungal prophylaxis. Itraconazole at a dose of 200 mg/day was indicated in all cases as secondary antifungal prophylaxis together with different antiretroviral drugs. This treatment was interrupted in all the cases that presented two CD4+ cell count >150/µl, had an undetectable HIV viral load and no signs or symptoms of progressive histoplasmosis. In 64% of patients the conditions for antifungal interruption were achieved in 12 months of prophylaxis. This group of patients was controlled for 12 to 24 months after antifungal discontinuation and no relapses were observed.
Initial treatment and secondary antifungal prophylaxis are highly effective in AIDS-related histoplasmosis. New antiretroviral drugs seem to get a faster restoration of immunity and a high proportion of the studied cases abandoned follow-up before ending clinical controls.
Histoplasmosis; Histoplasma capsulatum; AIDS-related infections; Systemic endemic mycoses; Opportunistic mycoses