Histoplasmosis in AIDS Patients in Venezuela

Histoplasmosis, caused by Histoplasma capsulatum, endemic in Venezuela, is the most frequent AIDS defining disease. It is associated with significant morbidity and mortality in these patients. The aim of this study was to review the demographic data, clinical features, diagnostic methods, treatment and follow-up, of patients with diagnosis of AIDS and histoplasmosis, evaluated at the Medical Mycology Department, Instituto de Medicina Tropical, Universidad Central de Venezuela, from 1994 to 2013. We collected demographic, epidemiologic, and clinical data from each case. Viral load and CD4+ counts were recorded when available. The diagnosis of histoplasmosis was performed by standard methods. Treatment and outcome was also considered. We found a high proportion of co-infection of HIV/AIDS and histoplasmosis, 39.42%, quite similar to other reports. The majority of patients, 149 (68.34%), came from urban environments. 155 had CD4+ counts below 150 cells/ mL. Out of these, 16 had previous ART. Adherence could not be established. In 79.8%, histoplasmosis was the AIDS-defining disease. All patients presented with a progressive disseminated disease. It is noteworthy that 9 (4.13%) patients were co-infected with Paracoccidioides brasiliensis. Finally, we believe that in our country, and what is more, in any other country in which histoplasmosis is endemic, it is necessary that clinicians consider the diagnosis of this disease, when they evaluate AIDS patients with fever, pulmonary, skin/mucosal, CNS or gastrointestinal manifestations and laboratory alterations such as cytopenias or liver enzyme abnormality. Physicians must be familiar with the uses and limitations of the current diagnostic tests available for fungal diseases.