Risk Factors for Disseminated Histoplasmosis in a Cohort of HIV-Infected Patients in French Guiana

Disseminated histoplasmosis is the first aids-defining infection in french guiana. a retrospective cohort study studied predictive factors of disseminated histoplasmosis in hiv-infected patients between 1996 and 2008. cox proportional hazards models were used. the variables studied were age,sex,last cd4/cd8 count,cd4 nadir,herpes or pneumocystosis,cotrimoxazole and fluconazole use,antiretroviral treatment and the notion of recent initiation of haart. a total of 1404 patients were followed for 6833 person-years. the variables independently associated with increased incidence of disseminated histoplasmosis were cd4 count<50 per mm3,cd4 count between 50 and 200 per mm3,a cd4 nadir <50 per mm3,cd8 count in the lowest quartile,herpes infection,and recent antiretroviral treatment initiation (less than 6 months). the variables associated with decreased incidence of histoplasmosis were antiretroviral treatment for more than 6 months,fluconazole treatment,and pneumocystosis. there were 13.5% of deaths at 1 month,17.5% at 3 months,and 22.5% at 6 months after the date of diagnosis of histoplasmosis. the most important predictive factors for death within 6 months of diagnosis were cd4 counts and antiretroviral treatment. the present study did not study environmental/occupational factors but provides predictive factors for disseminated histoplasmosis and its outcome in hiv patients in an amazonian environment during the haart era. © 2014 nacher et al.