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Disseminated Histoplasmosis in HIV-Infected Patients: A Description of 34 Years of Clinical and Therapeutic Practice

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CIC INSERM 1424, Centre Hospitalier Andree Rosemon Cayenne, 97300 Cayenne, French Guiana, France
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Département Formation Recherche Santé, Université de Guyane, Cayenne, 97300 Cayenne, French Guiana, France
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Equipe Opérationnelle d’Hygiène Hospitalière, Centre Hospitalier Andree Rosemon Cayenne, 97300 Cayenne, French Guiana, France
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Department of Dermatology, Centre Hospitalier Andree Rosemon Cayenne, 97300 Cayenne, French Guiana, France
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Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Andree Rosemon Cayenne, 97300 Cayenne, French Guiana, France
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Laboratory, Centre Hospitalier Andree Rosemon Cayenne, 97300 Cayenne, French Guiana, France
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Unité Mixte de Recherche Tropical Biome and Immunopathology, Université de Guyane, 97300 Cayenne, French Guiana, France
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Service de Médecine, Centre Hospitalier de l’Ouest Guyanais, 97320 Saint Laurent du Maroni, French Guiana, France
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Département d’Information Médicale, Centre Hospitalier de l’Ouest Guyanais, 97320 Saint Laurent du Maroni, French Guiana, France
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Department of Pathology, Centre Hospitalier Andrée Rosemon, 97300 Cayenne, French Guiana, France
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Author to whom correspondence should be addressed.
J. Fungi 2020, 6(3), 164; https://doi.org/10.3390/jof6030164
Received: 17 August 2020 / Revised: 1 September 2020 / Accepted: 4 September 2020 / Published: 7 September 2020
Disseminated histoplasmosis is the main AIDS-defining infection of French Guiana. We aim to describe our therapeutic experience for 349 patients with disseminated histoplasmosis between 1 January 1981 and 10 January 2014 in French Guiana. Survival, delays for treatment initiation, duration of induction therapy, and associated initial treatments are described. The death rate was 14.9 per 100 person-years, with an early drop in survival. Among those who died, >1/3 died within a year of HIV diagnosis, and ¾ of all patients with histoplasmosis had been diagnosed for HIV within a year. As induction treatment, 29% received liposomal amphotericin B, 12.9% received deoxycholate amphotericin B, 54% received itraconazole alone, and 21.8% received liposomal amphotericin B and itraconazole. The median delay between symptoms-onset and hospitalization was 19.5 days (IQR = 5–105). Liposomal amphotericin B or itraconazole was initiated shortly after admission. Treatment initiation was often presumptive for liposomal amphotericin B (27%) and itraconazole (20%). The median duration of liposomal amphotericin B treatment was 7 days (IQR = 5–11 days). The present study shows that ¾ of the patients were profoundly immunocompromised and had been diagnosed for HIV within the past year. Antifungal treatment was often initiated presumptively on admission. Over time there was a significant gradual decline in early death. View Full-Text
Keywords: disseminated histoplasmosis; HIV; treatment; case fatality; liposomal amphotericin B; French Guiana disseminated histoplasmosis; HIV; treatment; case fatality; liposomal amphotericin B; French Guiana
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Nacher, M.; Valdes, A.; Adenis, A.; Blaizot, R.; Abboud, P.; Demar, M.; Djossou, F.; Epelboin, L.; Misslin, C.; Ntab, B.; Drak Alsibai, K.; Couppié, P. Disseminated Histoplasmosis in HIV-Infected Patients: A Description of 34 Years of Clinical and Therapeutic Practice. J. Fungi 2020, 6, 164.

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