HISTOPLASMOSIS IN AIDS - ADVANCES IN MANAGEMENT

Histoplasmosis is one of the most common opportunistic infections in H IV-infected patients who reside in endemic areas, and ''imported infec tions'' also occur elsewhere. A recent decline in the incidence of his toplasmosis appears to correlate with advances in antiretroviral thera py. Histoplasmosis occurs due to either dissemination of newly acquire d infection or reactivation of latent foci of infection. Major risk fa ctors include a CD4 count less than or equal to 150/mu L, positive com plement fixation serology for the Histoplasma capsulatum mycelial anti gen, and a history of exposure to chicken coops; in addition, suboptim al antiretroviral therapy seems likely to be a risk factor. Although t here are a variety of clinical manifestations, most patients present w ith a several-week history of fever, chills, weakness, and weight loss . Diagnosis is based on positive cultures of blood, bone marrow, or ot her sites; detection of antigen in serum or urine; or characteristic h istopathologic findings in biopsy specimens. Induction therapy consist s of amphotericin B for acutely ill patients or itraconazole for patie nts with mild to moderately severe disease. Subsequent lifelong mainte nance therapy with itraconazole is recommended. In patients with CD4 c ounts of less than or equal to 150/mu L, itraconazole is effective pri mary prophylaxis.