Histoplasmosis in HIV-Infected Patients: A Review of New Developments and Remaining Gaps

Area of Science:

• Mycology
• Infectious Diseases
• Public Health

Background:

• Histoplasmosis, caused by *Histoplasma capsulatum*, is a globally distributed fungal infection impacting immunocompromised and immunocompetent individuals.
• Despite advances during the highly active antiretroviral therapy (HAART) era, histoplasmosis continues to cause significant morbidity and mortality, particularly in HIV-associated cases.
• The disease's burden is underestimated due to its status as a non-notifiable illness, leading to diagnostic challenges and delayed treatment.

Approach:

• This review synthesizes current published data on histoplasmosis, focusing on pathogenesis, diagnostics, and therapeutics.
• It identifies knowledge gaps and areas for future research to improve disease management.
• The approach highlights the need for accessible and affordable diagnostic and therapeutic tools in endemic regions.

Key Points:

• Histoplasmosis is frequently misdiagnosed as multidrug-resistant tuberculosis, resulting in preventable deaths.
• Recent advancements in understanding fungal DNA patterns and pathogenesis offer potential new therapeutic targets.
• Emerging diagnostic tools and therapeutics demonstrate promising clinical characteristics and potential for commercial availability.

Conclusions:

• There is a critical need to improve the recognition and diagnosis of histoplasmosis, particularly in HIV-infected populations.
• Future research should focus on developing and implementing accessible, affordable diagnostic and therapeutic strategies for histoplasmosis in endemic areas.
• Addressing diagnostic confusion with tuberculosis and ensuring wider availability of new treatments are crucial for reducing histoplasmosis-related mortality.