Incidence and trends in immune reconstitution inflammatory syndrome associated with Histoplasma capsulatum among people living with HIV: a 20-year case series and literature review.
Histoplasmosis is among the main AIDS-defining conditions in endemic areas. Although histoplasmosis has a worldwide distribution, histoplasmosis-associated immune reconstitution inflammatory syndrome (IRIS) in people living with HIV (PLHIV) is rarely reported.This study aimed to describe the incidence and features of histoplasmosis-associated IRIS in a cohort of PLHIV. A retrospective multicentric study was conducted in French Guiana from 01/01/1997 to 09/30/2017. The target population was represented by PLHIV who presented an episode of histoplasmosis within six 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. 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 person-years HIV-infected (CI95%: 0.43-1.05). Mean age was 40.5 years. Sex ratio M:F was 1.4. Median time to IRIS was 11 days [7-40] 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 one month was the rule. Twenty-two cases were identified in the literature with similar characteristics. 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.
PubMed Abstracts
PubMed Abstracts