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Prospective study of histoplasmosis in patients infected with human immunodeficiency virus: incidence, risk factors,

D S McKinsey1, R A Spiegel, L Hutwagner

  • 1Infectious Disease Associates of Kansas City, University of Missouri-Kansas City School of Medicine, St. Luke's Hospital, USA.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|June 1, 1997
PubMed

Insights

Histoplasmosis is a significant opportunistic infection for human immunodeficiency virus (HIV)-infected individuals in endemic areas. Key risk factors include prior exposure, positive serology, and low CD4+ counts, suggesting both reactivation and new infections contribute to disease.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Immunology

Background:

  • Histoplasmosis is a common opportunistic infection in human immunodeficiency virus (HIV)-infected individuals residing in areas endemic for Histoplasma capsulatum.
  • Understanding risk factors and pathophysiology is crucial for managing this infection in immunocompromised populations.

Purpose of the Study:

  • To define the incidence-specific risk factors and pathophysiology of histoplasmosis in a cohort of HIV-infected patients.
  • To identify predictive markers for symptomatic histoplasmosis in this population.

Main Methods:

  • Prospective study of 304 HIV-infected patients in Kansas City (October 1990-March 1993).
  • Data collection included patient history, serology for complement-fixing antibodies, CD4+ lymphocyte counts, histoplasmin reactivity, and pulmonary calcifications.
  • Incidence and risk factors for histoplasmosis were analyzed.

Main Results:

  • The annual incidence of histoplasmosis was 4.7%.
  • Symptomatic histoplasmosis occurred in 74% of cases, all disseminated.
  • Increased risk was associated with chicken coop exposure, positive baseline serology, and CD4+ counts < 150/microL.
  • Histoplasmin reactivity and pulmonary calcifications were not useful risk markers.
  • Symptomatic infection rates varied based on prior exposure and anergy status, suggesting dual pathophysiology.

Conclusions:

  • Chicken coop exposure, positive baseline serology, and low CD4+ counts are significant risk factors for histoplasmosis in HIV-infected individuals.
  • The pathophysiology of histoplasmosis in patients with acquired immunodeficiency syndrome (AIDS) likely involves both reactivation of latent infections and acquisition of new infections.
  • Clinical management should consider these risk factors and potential for diverse pathophysiological routes.

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