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Histoplasmosis and Tuberculosis Co-Occurrence in People with Advanced HIV
Open AccessCommunication

Getting Histoplasmosis on the Map of International Recommendations for Patients with Advanced HIV Disease

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Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, Uganda
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Global Action Fund for Fungal Infections, Rue Le Corbusier 12, 1208 Geneva, Switzerland
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Infectious Diseases Institute, College of Health Sciences, Makerere University, P.O. Box 22418, Kampala, Uganda
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Makerere University Lung Institute, College of Health Sciences, Makerere University, P.O. Box 7749, Kampala, Uganda
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The National Aspergillosis Centre, Wythenshawe Hospital, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M23 9LT, UK
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Author to whom correspondence should be addressed.
J. Fungi 2019, 5(3), 80; https://doi.org/10.3390/jof5030080
Received: 2 August 2019 / Revised: 23 August 2019 / Accepted: 30 August 2019 / Published: 2 September 2019
(This article belongs to the Special Issue Histoplasma and Histoplasmosis)
Progressive disseminated histoplasmosis, caused by H. capsulatum, is a life-threatening illness and is an AIDS-defining opportunistic infection. It is neglected, worryingly under-diagnosed, and often misdiagnosed as cancer or tuberculosis with fatal consequences. Globally, over 100,000 cases of disseminated histoplasmosis have been estimated. In 2017, the World Health Organization (WHO) noted that disseminated histoplasmosis is a significant cause of mortality in AIDS patients. Through the rigorous efforts of the Global Action Fund for Fungal Infections (GAFFI) and partners, in 2019, the Histoplasma antigen test was included on the 2nd Edition of the WHO List of Essential Diagnostics. The drugs used in the treatment of histoplasmosis (amphotericin B and itraconazole) are on the WHO Essential Medicine List. The Manaus Declaration on histoplasmosis in the Americas and the Caribbean, where histoplasmosis kills more people with HIV than tuberculosis, advocates for universal access to rapid testing for histoplasmosis and availability of essential drugs for the treatment of histoplasmosis in every country by 2025. Hyperendemic areas are present in the Americas, Caribbean, Southeast Asia, and Latin America. In conclusion, histoplasmosis remains an important clinical and public health problem. To reduce HIV-associated mortality, disseminated histoplasmosis must be addressed through advocacy, increased awareness, and universal access to essential diagnostics and antifungal agents. View Full-Text
Keywords: histoplasmosis; HIV; Histoplasma antigen tests; itraconazole; amphotericin B histoplasmosis; HIV; Histoplasma antigen tests; itraconazole; amphotericin B
MDPI and ACS Style

Bongomin, F.; Kwizera, R.; Denning, D.W. Getting Histoplasmosis on the Map of International Recommendations for Patients with Advanced HIV Disease. J. Fungi 2019, 5, 80.

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