OPPORTUNISTIC COCCIDIOIDOMYCOSIS IN PATIENTS INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS - PREVENTION ISSUES AND PRIORITIES

Coccidioidomycosis is an uncommon AIDS-defining illness that is endemi c in the southwestern United States. In profoundly immunodeficient pat ients infected with human immunodeficiency virus (HIV), the disease is usually manifest as severe pulmonary infection and is associated with high mortality, Although diagnosis is often made by routine serologic al tests, these appear to be less sensitive than when used for patient s who are not HIV-infected. New ways to diagnose the infection in HIV- infected patients earlier and with more certainty are urgently needed. The optimal antifungal regimen for active disease in HIV-infected pat ients is currently undefined, but following acute disease in severely immunocompromised HIV-infected patients (CD4 lymphocyte count, <200/mu L), lifelong systemic antifungal therapy is recommended. The role of chemoprophylaxis for HIV-infected patients in the area of endemic dise ase is also unclear. Improvement of preventive strategies must await t he results of well-designed future studies to determine risk factors, particularly environmental factors, for development of coccidioidomyco sis and to determine the proportion of disease due to new vs. reactiva ted infection, These studies are also needed to elucidate the role and efficacy of different types of antifungal drug therapies and the spec ific dosages useful for prevention, treatment, and long-term control o f these infections.