Next Article in Journal
In Vitro and In Vivo Antifungal Activity of Sorbicillinoids Produced by Trichoderma longibrachiatum
Next Article in Special Issue
Paediatric Histoplasmosis 2000–2019: A Review of 83 Cases
Previous Article in Journal
Potential Usage of Edible Mushrooms and Their Residues to Retrieve Valuable Supplies for Industrial Applications
Previous Article in Special Issue
Summary of Guidelines for Managing Histoplasmosis among People Living with HIV
Review

Treatment and Prevention of Histoplasmosis in Adults Living with HIV

Metro Infectious Disease Consultants, Kansas City, MO 64132, USA
Academic Editors: Nathan C. Bahr and Mathieu Nacher
J. Fungi 2021, 7(6), 429; https://doi.org/10.3390/jof7060429
Received: 6 May 2021 / Revised: 22 May 2021 / Accepted: 25 May 2021 / Published: 28 May 2021
(This article belongs to the Special Issue Histoplasma and Histoplasmosis 2020)
Histoplasmosis causes life-threatening disseminated infection in adult patients living with untreated HIV. Although disease incidence has declined dramatically in countries with access to antiretroviral therapy, histoplasmosis remains prevalent in many resource-limited regions. A high index of suspicion for histoplasmosis should be maintained in the setting of a febrile multisystem illness in severely immunosuppressed patients, particularly in persons with hemophagocytic lymphohistiocytosis. Preferred treatment regimens for initial therapy include liposomal amphotericin B for severe disease, or itraconazole for mild to moderate disease. Subsequently, itraconazole maintenance therapy should be administered for at least one year and then discontinued if CD4 count increases to ≥150 cells/µL. Antiretroviral therapy, which improves outcome when administered together with an antifungal agent, should be instituted immediately, as the risk of triggering Immune Reconstitution Syndrome is low. The major risk factor for relapsed infection is nonadherence. Itraconazole prophylaxis reduces risk for histoplasmosis in patients with CD4 counts <100/µL but is not associated with survival benefit and is primarily reserved for use in outbreaks. Although most patients with histoplasmosis have not had recognized high-risk exposures, avoidance of contact with bird or bat guano or inhalation of aerosolized soil in endemic regions may reduce risk. Adherence to effective antiretroviral therapy is the most important strategy for reducing the incidence of life-threatening histoplasmosis. View Full-Text
Keywords: histoplasmosis; HIV; amphotericin; itraconazole; fluconazole; voriconazole; posaconazole; prophylaxis; opportunistic infections; subaitraconazole histoplasmosis; HIV; amphotericin; itraconazole; fluconazole; voriconazole; posaconazole; prophylaxis; opportunistic infections; subaitraconazole
MDPI and ACS Style

McKinsey, D.S. Treatment and Prevention of Histoplasmosis in Adults Living with HIV. J. Fungi 2021, 7, 429. https://doi.org/10.3390/jof7060429

AMA Style

McKinsey DS. Treatment and Prevention of Histoplasmosis in Adults Living with HIV. Journal of Fungi. 2021; 7(6):429. https://doi.org/10.3390/jof7060429

Chicago/Turabian Style

McKinsey, David S. 2021. "Treatment and Prevention of Histoplasmosis in Adults Living with HIV" Journal of Fungi 7, no. 6: 429. https://doi.org/10.3390/jof7060429

Find Other Styles
Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

Article Access Map by Country/Region

1
Back to TopTop