Long-Term Mortality after Histoplasma Infection in People with HIV

Area of Science:

• Infectious Diseases
• Public Health
• HIV Medicine

Background:

• Histoplasmosis is a frequent opportunistic infection in people with HIV (PWH).
• Limited research exists on factors influencing long-term mortality in PWH diagnosed with histoplasmosis.

Purpose of the Study:

• To investigate factors associated with long-term mortality in people with HIV diagnosed with histoplasmosis.
• To compare outcomes between the pre-modern and modern antiretroviral therapy (ART) eras.

Main Methods:

• Retrospective, single-center study of 54 PWH diagnosed with histoplasmosis between 2002 and 2017.
• Patients categorized into early mortality (<90 days), late mortality (>=90 days), and long-term survivors.
• Analysis of survival based on ART era and insurance status as a proxy for socioeconomic status.

Main Results:

• Overall mortality was 37% (14.8% early, 22.2% late).
• No significant difference in survival was observed between the modern ART era and earlier periods (p=0.60).
• Private insurance was significantly associated with survival (38% of survivors vs. 8% in late mortality group, p=0.05).

Conclusions:

• High mortality from histoplasmosis persists in PWH despite advancements in ART.
• Social determinants of health, particularly insurance status, appear to play a crucial role in long-term survival.
• Further research is needed to fully understand the impact of these factors on PWH mortality.