Multicenter case-control study of risk factors for histoplasmosis in humanimmunodeficiency virus-infected persons

We conducted a multicenter case-control study to identify risk factors for histoplasmosis among persons with acquired immunodeficiency syndrome (AIDS) and to evaluate predictors of a poor outcome (defined as death or admissio n to the intensive care unit). Patients with histoplasmosis were each match ed by age, sex, and CD4 lymphocyte count to 3 controls. From 1996 through 1 999, 92 case patients and 252 controls were enrolled. Of the case patients, 81 (89%) were men, 50 (55%) were black, 78 (85%) had a CD4 lymphocyte coun t of <100 cells/<mu>L, 80 (87%) were hospitalized, and 11 (12%) died. Multi variable analysis found that receipt of antiretroviral therapy and of triaz ole drugs were independently associated with a decreased risk of histoplasm osis, Chronic medical conditions and a history of infections with herpes si mplex virus were associated with poor outcome. Triazoles should be consider ed for chemoprophylaxis for persons with AIDS, especially those who take pa rt in high-risk activities that involve frequent exposure to soil, who have CD4 lymphocyte counts of <100 cells/<mu>L, and who live in areas where his toplasmosis is endemic.