201. Incidence and Trends in Immune Reconstitution Inflammatory Syndrome Associated With Histoplasma capsulatum Among People Living With Human Immunodeficiency Virus: A 20-Year Case Series and Literature Review.
- Author
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Melzani, Alessia, Michel, Regis de Reynal de Saint, Ntab, Balthazar, Djossou, Felix, Epelboin, Loic, Nacher, Mathieu, Blanchet, Denis, Demar, Magalie, Couppie, Pierre, and Adenis, Antoine
- Subjects
DIAGNOSIS of fever ,HISTOPLASMOSIS diagnosis ,AIDS ,CONFIDENCE intervals ,DISEASES ,FUNGI ,HIV-positive persons ,INFORMED consent (Medical law) ,MEDICAL cooperation ,QUESTIONNAIRES ,RESEARCH ,ANTIRETROVIRAL agents ,DISEASE incidence ,RETROSPECTIVE studies ,CASE-control method ,IMMUNE reconstitution inflammatory syndrome ,DESCRIPTIVE statistics - Abstract
Background Histoplasmosis is among the main acquired immunodeficiency syndrome (AIDS)–defining conditions in endemic areas. Although histoplasmosis has a worldwide distribution, histoplasmosis-associated immune reconstitution inflammatory syndrome (IRIS) in people living with human immunodeficiency virus (PLHIV) is rarely reported. This study aimed to describe the incidence and features of histoplasmosis-associated IRIS in a cohort of PLHIV. Methods A retrospective multicenter study was conducted in French Guiana from 1 January 1997 to 30 September 2017. The target population was represented by PLHIV who presented an episode of histoplasmosis within 6 months after antiretroviral therapy initiation. We used a consensual IRIS case definition, submitted to the agreement of 2 experts. Each case was described using a standardized questionnaire, and all patients gave informed consent. Results Twenty-two cases of histoplasmosis-associated IRIS were included (14 infectious/unmasking and 8 paradoxical), with an overall incidence rate of 0.74 cases per 1000 HIV-infected person-years (95% confidence interval, 0.43–1.05). Mean age was 40.5 years. The ratio of males to females was 1:4. Median time to IRIS was 11 days (interquartile range 7–40 days) after antiretroviral therapy initiation. The main clinical presentation was fever, without any specific pattern, and disseminated disease. We reported 2 severe cases and partial or complete recovery at 1 month was the rule. Twenty-two cases were identified in the literature with similar characteristics. Conclusions Histoplasmosis-associated IRIS incidence was low but generated significant morbidity in PLHIV. In endemic areas, screening for latent or subclinical histoplasmosis should be implemented before antiretroviral therapy initiation. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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