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Summary of Guidelines for Managing Histoplasmosis among People Living with HIV
Freddy Perez1, Diego H Caceres2,3, Nathan Ford4
1HIV, Hepatitis, Tuberculosis and Sexually Transmitted Infections Unit, Communicable Diseases and Environmental Determinants of Health Department, Pan American Health Organization, Washington, DC 20037, USA.
Abstract:
Histoplasmosis is a frequent fungal opportunistic infection in people living with HIV (PLHIV), associated every year to a total of 5% to 15% of AIDS-related deaths among this population. In 2020, the first global guidelines for diagnosing and managing disseminated histoplasmosis among PLHIV was published. This document recommends (1) detection of circulating Histoplasma antigens as the recommended laboratory assay to diagnose histoplasmosis among PLHIV; (2) the use of liposomal amphotericin for induction therapy in severe or moderately severe disease, followed by a maintenance therapy with itraconazole for 12 months; a shorter maintenance therapy could be considered if the patient is clinically stable and if immune status has improved; (3) antiretroviral therapy initiation as soon as possible among patients with histoplasmosis without involvement of central nervous system; and (4) that for the treatment of co-infection with histoplasmosis and tuberculosis (TB), treatment of TB should be initiated according to the World Health Organization treatment guidelines. Appropriate health education of providers, supportive supervision, and policy guidance for the care of PLHIV are required.
Insights
Disseminated histoplasmosis is a common opportunistic infection in people living with HIV. New guidelines recommend antigen detection for diagnosis and specific antifungal therapies, alongside early antiretroviral treatment.
Area of Science:
- Infectious Diseases
- Mycology
- Public Health
Background:
- Histoplasmosis is a significant opportunistic fungal infection in people living with HIV (PLHIV).
- It contributes to 5%-15% of AIDS-related deaths annually in this population.
- The first global guidelines for disseminated histoplasmosis in PLHIV were published in 2020.
Purpose of the Study:
- To summarize the key recommendations from the 2020 global guidelines for diagnosing and managing disseminated histoplasmosis in PLHIV.
- To highlight the importance of integrated care strategies for PLHIV with histoplasmosis.
Main Methods:
- The content is based on the synthesis of recommendations from the 2020 global guidelines.
- Key diagnostic and therapeutic strategies are outlined.
- Considerations for co-infection and integrated care are discussed.
Main Results:
- Recommends circulating *Histoplasma* antigen detection for diagnosis.
- Advocates liposomal amphotericin B for induction therapy, followed by 12-month itraconazole maintenance.
- Suggests early antiretroviral therapy initiation and adherence to WHO TB guidelines for co-infections.
Conclusions:
- Effective management of disseminated histoplasmosis in PLHIV requires prompt diagnosis and appropriate treatment.
- Integrated care, including early ART and co-infection management, is crucial.
- Provider education, supervision, and policy support are essential for optimal patient outcomes.
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