ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
نسخه الکترونیک
medimedia.ir

Treatment of histoplasmosis in patients with HIV

Treatment of histoplasmosis in patients with HIV
Literature review current through: Jan 2024.
This topic last updated: Nov 10, 2023.

INTRODUCTION — Histoplasmosis is an important infectious disease among patients with HIV and continues to cause severe morbidity and mortality in endemic areas, particularly in resource-limited settings [1-4].

Treatment of histoplasmosis will be discussed here. The epidemiology, clinical manifestations, and diagnosis of histoplasmosis are discussed elsewhere. (See "Epidemiology, clinical manifestations, and diagnosis of histoplasmosis in patients with HIV".)

APPROACH TO TREATMENT — Rapid initiation of therapy is indicated due to the high mortality of disseminated disease. Treatment involves an acute phase of initial (sometimes referred to as induction therapy), followed by long-term step-down therapy [1].

Treatment approaches should be categorized on the basis of immune function and severity of illness:

Patients with severe immunosuppression, disseminated disease, sepsis-like syndromes, high fever, clinical instability, or findings such as respiratory failure, other organ dysfunction, or pancytopenia should be classified as having moderately severe to severe disease. Treatment of moderately severe to severe disease requires an amphotericin B formulation as the front-line agent.

Patients with mild clinical symptoms and/or a single focus of disease (other than the central nervous system [CNS]) have mild to moderate disease and can receive initial itraconazole therapy.

In order to prevent relapse, maintenance therapy is indicated in patients who remain highly immunosuppressed (see 'Maintenance therapy' below). Maintenance therapy and treatment of mild to moderate disease are best managed with itraconazole.

Details of therapeutic management and discussion of available antifungal agents follow below.

Moderately severe to severe disease — Disseminated histoplasmosis in patients with human immunodeficiency virus (HIV) is fatal without therapeutic intervention. Guidelines from the Centers for Disease Control and Prevention (CDC), National Institutes of Health, the HIV Medicine Association (HIVMA), the Infectious Diseases Society of America (IDSA), and WHO/Pan American Health Organization (PAHO) recommend liposomal amphotericin B (3 mg/kg daily) as initial treatment for patients with HIV and moderately severe to severe disease due to its greater efficacy, lower toxicity, and better overall survival (table 1) [1,5-7]. Treatment with amphotericin B should continue for two weeks or until clinical improvement.

Lipid formulations of amphotericin B are preferred. Deoxycholate AmB (1 mg/kg daily) is an alternative if lipid formulations are not available or if the cost is prohibitive (table 1). (See "Amphotericin B nephrotoxicity".)

After initial therapy, patients can be switched to itraconazole as "step down" therapy [8]. A loading dose of 200 mg three times daily for three days is followed by maintenance doses of 200 mg twice daily thereafter [1]. Itraconazole is available in various oral formulations. (See 'Duration of therapy' below.)

Itraconazole is available in various oral formulations (eg, capsules, liquid). Choice of formulation is mainly determined by availability. A detailed discussion of differences in formulations, drug interactions, and food requirements is found elsewhere. (See "Pharmacology of azoles".)

Liposomal amphotericin B has been demonstrated to be more effective and safer than amphotericin B deoxycholate. In a double-blinded multicenter randomized trial of 81 patients with acquired immunodeficiency syndrome (AIDS) and moderately severe to severe disease, those who received liposomal amphotericin B (3 mg/kg daily) for the initial phase had higher clinical response rates (eg, resolution of fever; 88 versus 64 percent) and lower rates of nephrotoxicity (9 versus 37 percent) compared with those who received amphotericin B deoxycholate (0.7 mg/kg daily) [9]. At the end of the initial phase, there was no significant difference in the time to negative cultures in either arm. Patient survival was also significantly higher in patients receiving liposomal amphotericin B; one of 53 patients (2 percent) in the liposomal amphotericin B arm died of bacterial sepsis while 3 of 24 (13 percent) in the deoxycholate arm died of disseminated histoplasmosis. Limitations of the above trial include the dosing regimen of amphotericin B deoxycholate of only 0.7 mg/kg.

Higher doses and shorter duration of liposomal amphotericin B may be as safe and effective as the standard 14-day duration of liposomal amphotericin B. In a phase 2 trial that assigned 118 participants with AIDS and disseminated histoplasmosis to receive a single dose of liposomal amphotericin B (10 mg/kg), two doses of liposomal amphotericin B spaced 3 days apart (10 mg/kg on day 1 followed by 5 mg/kg on day 3), or the standard 14-day course of daily liposomal amphotericin B (3 mg/kg daily), clinical response and overall patient survival at the end of 14 days were similar between the one-dose and the standard 14-day therapy group [10]. Although promising, the study is small, and a confirmatory phase 3 study is needed in order to apply this in clinical practice.  

Mild to moderate disease — Initial therapy with itraconazole is preferred in patients with HIV who have mild to moderate disease severity and non-meningeal involvement (table 1) [11,12]. In a multicenter open-label study of 59 patients with disseminated histoplasmosis without meningeal involvement, itraconazole led to resolution of clinical symptoms in 85 percent of cases after 12 weeks of therapy [11]. However, patients with more severe disease at baseline (fever >39.5º Celsius or Karnofsky score <60) or certain laboratory abnormalities (alkaline phosphatase >5 times normal or albumin <3 g/dL) tended to respond more poorly than did other patients. These data suggest that patients with severe disease at baseline should undergo initial therapy with amphotericin B.

For patients with AIDS and disseminated histoplasmosis, at least 12 months of therapy is required for mild, moderate, or severe disease [6].

We do not recommend itraconazole for initial therapy for patients with fungemia, or other evidence of disseminated infection, since sterilization of blood cultures is slower with this fungistatic agent [9].

Although there are no direct comparative studies, the data suggest that fluconazole is not as active against Histoplasma as itraconazole and should not be used as first-line therapy for even mild or moderate disease [13]. In one multicenter open-label study, 36 patients with mild to moderate disseminated histoplasmosis received fluconazole (800 mg daily); seven patients failed initial therapy with fluconazole and one patient died. Furthermore, of 36 patients who entered into the one-year maintenance phase of the study, one-third of the patients relapsed.

A subsequent study demonstrated that patients with microbiologic failure on fluconazole had developed drug resistance [14]. There was at least a fourfold increase in fluconazole minimal inhibitory concentration (MIC) in the isolates from 10 of 17 patients for whom paired pretreatment and post-treatment isolates were available. Cross-resistance to itraconazole was not found among these isolates.

Meningitis — There are no trials evaluating treatment regimens for CNS histoplasmosis. We agree with the IDSA and CDC recommendations of liposomal amphotericin B (5 mg/kg daily) for a total of 175 mg/kg (given over four to six weeks) followed by itraconazole (200 mg two to three times daily) for a minimum of one year or until resolution of cerebrospinal fluid abnormalities (including serum and CNS Histoplasma antigen) [1,6]. We prefer three times daily administration of itraconazole due to its poor penetration into the CNS.

A study of mainly patients with AIDS and with a variety of fungal CNS infections reported one patient who was refractory to amphotericin B and who subsequently responded to posaconazole [15]. (See "Pharmacology of azoles".)

Antifungal agents — The two most commonly used agents for the treatment of histoplasmosis include amphotericin B and itraconazole. Amphotericin B is usually used for initial therapy and oral itraconazole is used for step-down therapy and long-term maintenance therapy.

Guidelines for the treatment of histoplasmosis were published by the Infectious Diseases Society of America in 2007 [6] and the World Health Organization (WHO) in 2020 [5]; an overview of the treatment of histoplasmosis in immunocompetent hosts is discussed elsewhere [6]. Treatment of the patient with HIV and disseminated histoplasmosis is discussed below.

Amphotericin B — Amphotericin B is considered first-line therapy for patients with HIV and severe disseminated disease [6,16] and for patients with CNS involvement because it is fungicidal and leads to faster clearance of fungemia compared with the fungistatic dug itraconazole. [11]. Also, several days of a loading dose are required for the levels of itraconazole to reach steady state. The disadvantages of amphotericin B preparations are requirements for a central venous catheter as well as infusion-related toxicities and nephrotoxicity. (See "Amphotericin B nephrotoxicity".)

Itraconazole — Itraconazole is the preferred oral azole for histoplasmosis. It has better in vitro activity than fluconazole and excellent clinical response rates [11,17,18]. In one review of 12 patients with AIDS and disseminated disease, 11 patients responded to itraconazole [19]. Furthermore, the development of resistance to itraconazole during therapy has not been reported [20]. (See "Pharmacology of azoles".)

Fluconazole — Fluconazole is not as active in vitro against H. capsulatum as itraconazole and leads to slower clearance of fungemia [13,17]. For example, in one study, a significantly higher proportion of patients cleared fungemia after four weeks of therapy in the itraconazole arm than in the fluconazole arm (92 versus 62 percent) [17].

In a multicenter, open-label, nonrandomized prospective trial of 49 patients with HIV and mild or moderately severe histoplasmosis, more than one-quarter had progression of disease on initial therapy and approximately one-third relapsed despite stepdown therapy with 400 mg of daily fluconazole [13]. Furthermore, in 10 of 17 patients for whom there were paired pretreatment and failure or relapse isolates available, at least a fourfold increase in the minimal inhibitory concentration (MIC) for fluconazole was demonstrated consistent with the development of resistance during fluconazole therapy [14].

Other agents — The role of other azoles, such as voriconazole, posaconazole, and isavuconazole, is unclear for the treatment of histoplasmosis in patients with HIV because they have not been studied in this group of patients; however, all have good in vitro activity against Histoplasma, and voriconazole and posaconazole have been reported to be effective in patients without HIV [21-30]. (See "Diagnosis and treatment of disseminated histoplasmosis in patients without HIV" and "Pharmacology of azoles".)

There is no evidence to support the use of echinocandins in the treatment of histoplasmosis, and they should not be used.

DRUG INTERACTIONS — Careful assessment for possible drug interactions with itraconazole use is recommended. Adverse events due to itraconazole are discussed in detail elsewhere. (See "Pharmacology of azoles".)

Concomitant administration of nephrotoxic drugs with amphotericin B is discouraged, whenever possible.

DURATION OF THERAPY — The initial course of therapy should be at least one year for disseminated histoplasmosis. Treatment should continue until clinical symptoms have resolved. Prompt initiation of antiretroviral therapy (ART) is recommended, if applicable. A shorter duration of antifungal therapy (eg, six months) has been used by some practicing clinicians if the patient is clinically stable, has a negative Histoplasma antigen, is receiving antiretroviral therapy, has suppressed viral loads, and the immune status has improved [5]. However, there are no studies evaluating the impact of shorter duration of therapy on outcomes in patients with HIV, thus we prefer to treat histoplasmosis for at least one year in all patients with HIV.

Life-long maintenance therapy may be necessary for patients with HIV who do not achieve immune recovery on ART due to the risk of relapse. Furthermore, those patients who experience relapse after completion of the initial course of therapy should be considered for lifelong prophylaxis, regardless of whether successful immune recovery has occurred [6]. (See 'Maintenance therapy' below.)

MONITORING OF PATIENTS — In addition to frequent clinical follow-up, antigen levels should be assayed every few months during therapy to assess treatment response. Antigen levels should also be obtained for up to 6 months after completion of therapy to determine early signs of relapse [6].

Antigen monitoring should be considered if relapse is suspected based on clinical symptoms or if CD4 cell counts decline to less than 100 cells/microL.

Serum levels of itraconazole are recommended to determine adequacy of drug exposure, particularly in light of potential drug interactions [31,32]. The serum concentration should be at least 1 mcg/mL, ideally drawn after 14 days on the current regimen. (See "Pharmacology of azoles".)

IMMUNE RECONSTITUTION — Antiretroviral therapy (ART) leads to restoration of T cell immunity, which is an important mediator of defense against histoplasmosis. Immune reconstitution can sometimes complicate treatment of other opportunistic infections; however, immune reconstitution inflammatory syndrome (IRIS) has been uncommonly reported in the setting of disseminated histoplasmosis. A study in French Guiana identified 22 cases of histoplasmosis-associated IRIS, with an incidence rate of 0.74 cases per 1000 person-years, IRIS developed a median of 11 days (interquartile range, 7 to 40 days) after ART initiation [33].

In a series of four patients with disseminated histoplasmosis, immune reconstitution led to clinical presentations of liver abscesses, compressive lymphadenitis, intestinal obstruction, uveitis and arthritis within a median of 45 days after initiation of potent ART [34].

However, one study suggested that patients who were also taking ART had better overall treatment outcomes for histoplasmosis [35]. Thus, ART should not be withheld due to concerns regarding IRIS. (See 'Morbidity and mortality' below and "Immune reconstitution inflammatory syndrome".)

MORBIDITY AND MORTALITY — Morbidity and mortality secondary to disseminated histoplasmosis remains high in patients who are not taking ART or who have multi-drug resistant HIV [2,36,37]. A retrospective study was performed in 46 patients with HIV who were diagnosed with histoplasmosis from 1999 to 2006, 93 percent of whom had disseminated disease [2]. Histoplasmosis was the first manifestation of HIV infection in approximately one-quarter of the patients. Among those with previously diagnosed HIV infection, only 21 percent were taking ART and none had viral suppression at the time of diagnosis. At the three-month follow-up, 39 percent of the patients had died.

Disseminated histoplasmosis is also an important cause of death in resource-limited settings where the vast majority of patients present with advanced untreated HIV infection [38-40].

Prognostic factors — Patients with HIV and disseminated histoplasmosis who present with severe respiratory and renal impairment and/or fungemia have a poor prognosis [2,38]. In one retrospective study of 378 patients with HIV in Brazil, the mortality in patients with disseminated histoplasmosis (n = 164) was higher than in those with other opportunistic infections (32 versus 14 percent) [41]. In one study from Europe, autopsy data in 13 patients with AIDS confirmed the widespread disseminated nature of histoplasmosis in this patient population with a median of 4.5 organs involved [42].

Laboratory markers that have been associated with poor clinical outcome include elevated lactate dehydrogenase, elevated creatinine, thrombocytopenia, anemia, elevated C-reactive protein, and hypoalbuminemia [2,43].

MAINTENANCE THERAPY — Fifty to 80 percent of patients with histoplasmosis and AIDS will relapse if prolonged, maintenance therapy is not continued [44]. Itraconazole prevents relapse in up to 95 percent of cases [45], and should be administered continually if immune recovery is not achieved with antiretroviral therapy (ART) (table 1) [1,5].

However, data suggest that maintenance therapy with itraconazole may be discontinued safely if patients fulfill all of the following criteria [8,45-47]:

Completion of a minimum of one-year of therapy. (See 'Approach to treatment' above.)

Histoplasma antigen levels are negative or remain near the lower level of detection.

Blood cultures are negative.

CD4 cell counts are >150 cells/microL for ≥6 months in response to ART

Patient remains on ART with a suppressed HIV viral load ≥6 months.

Maintenance therapy should be resumed if the patient discontinues ART or if there is evidence of loss of immune recovery (eg, viral load increase, decline in CD4 cell count to ≤150 cells/microL).

For patients who relapse after completing an appropriate initial course of therapy, long-term maintenance therapy should be considered after retreatment, regardless of whether successful immune recovery has occurred [1,6]. Such patients should be managed in consultation with an infectious diseases provider experienced in the treatment of histoplasmosis.

PREVENTION — Patients with a CD4 count ≤150 cells/microL should avoid, if possible, occupations and activities that put them at high risk for developing histoplasmosis if they visit, or reside in, areas where histoplasmosis is endemic (eg, the Mississippi and Ohio river valleys, the Caribbean, southern Mexico, and certain parts of Central and South America, Africa, and Asia). Such activities include working with surface soil, cleaning chicken coops that are contaminated with droppings, disturbing areas contaminated with bird or bat droppings, exploring caves, and cleaning, remodeling, or demolishing old buildings. Although there are no data to support this approach, we feel that it is prudent to avoid these exposures in such immunocompromised hosts. (See "Epidemiology, clinical manifestations, and diagnosis of histoplasmosis in patients with HIV".)

In general, we do not administer antifungal prophylaxis with itraconazole to prevent primary infection with histoplasmosis, because there are limited data to suggest the efficacy of prophylaxis, and most patients will have immune recovery (ie, increased CD4 count) on antiretroviral therapy. However, in areas in which Histoplasma is hyperendemic (>10 cases/100 patient-years), such as certain parts of South America and French Guiana, some providers administer itraconazole (200 mg daily) to patients with CD4 counts ≤150 cells/microL [1]. This is based on a randomized controlled trial in which itraconazole reduced the frequency of histoplasmosis, but not mortality, in patients with HIV and low CD4 cell counts [48]. For patients who receive prophylactic therapy, itraconazole can be discontinued among patients receiving antiretroviral therapy when the CD4 count is ≥150 cells/microL for at least six months.

SOCIETY GUIDELINE LINKS — Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. (See "Society guideline links: Opportunistic infections in adults with HIV" and "Society guideline links: Histoplasmosis".)

INFORMATION FOR PATIENTS — UpToDate offers two types of patient education materials, "The Basics" and "Beyond the Basics." The Basics patient education pieces are written in plain language, at the 5th to 6th grade reading level, and they answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are written at the 10th to 12th grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon.

Here are the patient education articles that are relevant to this topic. We encourage you to print or e-mail these topics to your patients. (You can also locate patient education articles on a variety of subjects by searching on "patient info" and the keyword(s) of interest.)

Basics topic (see "Patient education: Histoplasmosis (The Basics)")

SUMMARY AND RECOMMENDATIONS

General Histoplasmosis is an important cause of morbidity and mortality in patients living in endemic areas who are not taking antiretroviral therapy (ART). (See 'Introduction' above.)

Approach to treatment

Moderately severe or severe non-meningeal disease – For patients with severe progressive disseminated histoplasmosis, we recommend initial therapy with liposomal amphotericin B (3 mg/kg daily) for two weeks (table 1) (Grade 1B). We also recommend step-down therapy for a minimum of one year to prevent relapse (Grade 1B). We prefer itraconazole (200 mg three times daily for three days followed by 200 mg twice daily) for step-down therapy due to its excellent activity against Histoplasma in comparison with other azoles. (See 'Moderately severe to severe disease' above.)

Mild to moderate non-meningeal disease For patients with HIV and mild to moderate nonmeningeal disease, we recommend treatment with itraconazole (200 mg three times daily for three days followed by 200 mg twice daily) for a minimum of one year (Grade 1B). (See 'Mild to moderate disease' above.)

Meningeal disease – For patients with central nervous system disease, we recommend liposomal amphotericin B (5 mg/kg daily) for a total of 175 mg/kg (given over four to six weeks) as initial therapy (Grade 1C). We recommend itraconazole (200 mg two to three times daily) for step-down therapy for a minimum of one year and until resolution of cerebrospinal fluid abnormalities. (See 'Meningitis' above.)

Duration of therapy – ART should be initiated as soon as possible to improve cellular immunity. Lifelong maintenance therapy with itraconazole may be needed in patients who do not achieve immune recovery on ART. (See 'Duration of therapy' above.)

Monitoring of patients – In addition to frequent clinical follow-up, antigen levels should be assayed during therapy to assess treatment response. For patients on itraconazole, serum levels should also be monitored. (See 'Monitoring of patients' above.)

Morbidity and mortality – Patients with HIV and disseminated histoplasmosis who present with severe respiratory and renal impairment and/or fungemia have a poor prognosis. (See 'Morbidity and mortality' above.)

Maintenance therapy Maintenance therapy with itraconazole should be administered until the patient has received therapy with an azole for >1 year, has a CD4 cell count greater than 150 cells/microL for at least six months in response to ART (and remains on ART with a suppressed HIV viral load), and has no laboratory evidence of ongoing infection (negative fungal blood cultures, Histoplasma antigen level near the lower level of detection) (table 1). (See 'Maintenance therapy' above.)

Prevention

Patients with HIV and a CD4 count ≤150 cells/microL who live in endemic areas should avoid recreational and/or occupational exposures that put them at high-risk for infection. (See 'Prevention' above.)

In general, we do not administer antifungal prophylaxis with itraconazole to prevent primary infection with histoplasmosis. However, in areas where Histoplasma is hyperendemic (>10 cases/100 patient-years), some providers administer itraconazole to patients with CD4 counts ≤150 cells/microL. (See 'Prevention' above.)

ACKNOWLEDGMENT — UpToDate gratefully acknowledges John G Bartlett, MD (deceased), who contributed as Section Editor on earlier versions of this topic and was a founding Editor-in-Chief for UpToDate in Infectious Diseases.

  1. Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association, and Infectious Diseases Society of America. https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/histoplasmosis?view=full (Accessed on June 26, 2023).
  2. Baddley JW, Sankara IR, Rodriquez JM, et al. Histoplasmosis in HIV-infected patients in a southern regional medical center: poor prognosis in the era of highly active antiretroviral therapy. Diagn Microbiol Infect Dis 2008; 62:151.
  3. Nacher M, Valdes A, Adenis A, et al. Disseminated Histoplasmosis in HIV-Infected Patients: A Description of 34 Years of Clinical and Therapeutic Practice. J Fungi (Basel) 2020; 6.
  4. McKinsey DS. Treatment and Prevention of Histoplasmosis in Adults Living with HIV. J Fungi (Basel) 2021; 7.
  5. Pan American Health Organization and World Health Organization. Guidelines for Diagnosing and Managing Disseminated Histoplasmosis among People Living with HIV. https://iris.paho.org/handle/10665.2/52304 (Accessed on June 26, 2023).
  6. Wheat LJ, Freifeld AG, Kleiman MB, et al. Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis 2007; 45:807.
  7. Murray M, Hine P. Treating progressive disseminated histoplasmosis in people living with HIV. Cochrane Database Syst Rev 2020; 4:CD013594.
  8. Wheat J. Histoplasmosis. Experience during outbreaks in Indianapolis and review of the literature. Medicine (Baltimore) 1997; 76:339.
  9. Johnson PC, Wheat LJ, Cloud GA, et al. Safety and efficacy of liposomal amphotericin B compared with conventional amphotericin B for induction therapy of histoplasmosis in patients with AIDS. Ann Intern Med 2002; 137:105.
  10. Pasqualotto AC, Lana DD, Godoy CSM, et al. Single High Dose of Liposomal Amphotericin B in Human Immunodeficiency Virus/AIDS-Related Disseminated Histoplasmosis: A Randomized Trial. Clin Infect Dis 2023; 77:1126.
  11. Wheat J, Hafner R, Korzun AH, et al. Itraconazole treatment of disseminated histoplasmosis in patients with the acquired immunodeficiency syndrome. AIDS Clinical Trial Group. Am J Med 1995; 98:336.
  12. Dismukes WE, Bradsher RW Jr, Cloud GC, et al. Itraconazole therapy for blastomycosis and histoplasmosis. NIAID Mycoses Study Group. Am J Med 1992; 93:489.
  13. Wheat J, MaWhinney S, Hafner R, et al. Treatment of histoplasmosis with fluconazole in patients with acquired immunodeficiency syndrome. National Institute of Allergy and Infectious Diseases Acquired Immunodeficiency Syndrome Clinical Trials Group and Mycoses Study Group. Am J Med 1997; 103:223.
  14. Wheat LJ, Connolly P, Smedema M, et al. Emergence of resistance to fluconazole as a cause of failure during treatment of histoplasmosis in patients with acquired immunodeficiency disease syndrome. Clin Infect Dis 2001; 33:1910.
  15. Pitisuttithum P, Negroni R, Graybill JR, et al. Activity of posaconazole in the treatment of central nervous system fungal infections. J Antimicrob Chemother 2005; 56:745.
  16. Lanternier F, Lortholary O. Liposomal amphotericin B: what is its role in 2008? Clin Microbiol Infect 2008; 14 Suppl 4:71.
  17. Wheat LJ, Connolly P, Haddad N, et al. Antigen clearance during treatment of disseminated histoplasmosis with itraconazole versus fluconazole in patients with AIDS. Antimicrob Agents Chemother 2002; 46:248.
  18. Wheat J, Hafner R, Wulfsohn M, et al. Prevention of relapse of histoplasmosis with itraconazole in patients with the acquired immunodeficiency syndrome. Ann Intern Med 1993; 118:610.
  19. Hostetler JS, Denning DW, Stevens DA. US experience with itraconazole in Aspergillus, Cryptococcus and Histoplasma infections in the immunocompromised host. Chemotherapy 1992; 38 Suppl 1:12.
  20. Brooks JT, Wheat LJ. Histoplasmosis: update 1998. AIDS Clin Care 1998; 10:4.
  21. Freifeld AG, Iwen PC, Lesiak BL, et al. Histoplasmosis in solid organ transplant recipients at a large Midwestern university transplant center. Transpl Infect Dis 2005; 7:109.
  22. Freifeld A, Proia L, Andes D, et al. Voriconazole use for endemic fungal infections. Antimicrob Agents Chemother 2009; 53:1648.
  23. Kauffman CA, Freifeld AG, Andes DR, et al. Endemic fungal infections in solid organ and hematopoietic cell transplant recipients enrolled in the Transplant-Associated Infection Surveillance Network (TRANSNET). Transpl Infect Dis 2014; 16:213.
  24. Grim SA, Proia L, Miller R, et al. A multicenter study of histoplasmosis and blastomycosis after solid organ transplantation. Transpl Infect Dis 2012; 14:17.
  25. Cuellar-Rodriguez J, Avery RK, Lard M, et al. Histoplasmosis in solid organ transplant recipients: 10 years of experience at a large transplant center in an endemic area. Clin Infect Dis 2009; 49:710.
  26. Luckett K, Dummer JS, Miller G, et al. Histoplasmosis in Patients With Cell-Mediated Immunodeficiency: Human Immunodeficiency Virus Infection, Organ Transplantation, and Tumor Necrosis Factor-α Inhibition. Open Forum Infect Dis 2015; 2:ofu116.
  27. Dhawan J, Verma P, Sharma A, et al. Disseminated cutaneous histoplasmosis in an immunocompetent child, relapsed with itraconazole, successfully treated with voriconazole. Pediatr Dermatol 2010; 27:549.
  28. Srinivasan J, Ooi WW. Successful treatment of histoplasmosis brain abscess with voriconazole. Arch Neurol 2008; 65:666.
  29. Ramireddy S, Wanger A, Ostrosky L. An instructive case of CNS histoplasmosis in an immunocompetent host. Med Mycol Case Rep 2012; 1:69.
  30. Prinapori R, Mikulksa M, Parisini A, et al. A case of cerebral histoplasmosis in an immunocompetent host successfully treated with voriconazole. Infect Dis Trop Med 2015; 1:e90.
  31. Huet E, Hadji C, Hulin A, et al. Therapeutic monitoring is necessary for the association itraconazole and efavirenz in a patient with AIDS and disseminated histoplasmosis. AIDS 2008; 22:1885.
  32. Koo HL, Hamill RJ, Andrade RA. Drug-drug interaction between itraconazole and efavirenz in a patient with AIDS and disseminated histoplasmosis. Clin Infect Dis 2007; 45:e77.
  33. Melzani A, de Reynal de Saint Michel R, Ntab B, et al. Incidence and Trends in Immune Reconstitution Inflammatory Syndrome Associated With Histoplasma capsulatum Among People Living With Human Immunodeficiency Virus: A 20-Year Case Series and Literature Review. Clin Infect Dis 2020; 70:643.
  34. Breton G, Adle-Biassette H, Therby A, et al. Immune reconstitution inflammatory syndrome in HIV-infected patients with disseminated histoplasmosis. AIDS 2006; 20:119.
  35. Tobón AM, Agudelo CA, Rosero DS, et al. Disseminated histoplasmosis: a comparative study between patients with acquired immunodeficiency syndrome and non-human immunodeficiency virus-infected individuals. Am J Trop Med Hyg 2005; 73:576.
  36. Nacher M, Drak Alsibai K, Valdes A, et al. Risk Factors for Mortality among HIV-Infected Patients with Disseminated Histoplasmosis. J Fungi (Basel) 2020; 6.
  37. Cherabie J, Mazi P, Rauseo AM, et al. Long-Term Mortality after Histoplasma Infection in People with HIV. J Fungi (Basel) 2021; 7.
  38. Couppié P, Aznar C, Carme B, Nacher M. American histoplasmosis in developing countries with a special focus on patients with HIV: diagnosis, treatment, and prognosis. Curr Opin Infect Dis 2006; 19:443.
  39. Huber F, Nacher M, Aznar C, et al. AIDS-related Histoplasma capsulatum var. capsulatum infection: 25 years experience of French Guiana. AIDS 2008; 22:1047.
  40. Adenis A, Nacher M, Hanf M, et al. HIV-associated histoplasmosis early mortality and incidence trends: from neglect to priority. PLoS Negl Trop Dis 2014; 8:e3100.
  41. Daher EF, Silva GB Jr, Barros FA, et al. Clinical and laboratory features of disseminated histoplasmosis in HIV patients from Brazil. Trop Med Int Health 2007; 12:1108.
  42. Antinori S, Magni C, Nebuloni M, et al. Histoplasmosis among human immunodeficiency virus-infected people in Europe: report of 4 cases and review of the literature. Medicine (Baltimore) 2006; 85:22.
  43. Françoise U, Nacher M, Bourne-Watrin M, et al. Development of a case fatality prognostic score for HIV-associated histoplasmosis. Int J Infect Dis 2023; 132:26.
  44. Drew RH. Pharmacotherapy of disseminated histoplasmosis in patients with AIDS. Ann Pharmacother 1993; 27:1510.
  45. Hecht FM, Wheat J, Korzun AH, et al. Itraconazole maintenance treatment for histoplasmosis in AIDS: a prospective, multicenter trial. J Acquir Immune Defic Syndr Hum Retrovirol 1997; 16:100.
  46. Goldman M, Zackin R, Fichtenbaum CJ, et al. Safety of discontinuation of maintenance therapy for disseminated histoplasmosis after immunologic response to antiretroviral therapy. Clin Infect Dis 2004; 38:1485.
  47. Myint T, Anderson AM, Sanchez A, et al. Histoplasmosis in patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS): multicenter study of outcomes and factors associated with relapse. Medicine (Baltimore) 2014; 93:11.
  48. McKinsey DS, Wheat LJ, Cloud GA, et al. Itraconazole prophylaxis for fungal infections in patients with advanced human immunodeficiency virus infection: randomized, placebo-controlled, double-blind study. National Institute of Allergy and Infectious Diseases Mycoses Study Group. Clin Infect Dis 1999; 28:1049.
Topic 6996 Version 30.0

References

آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟