Disseminated histoplasmosis in HIV-infected patients: determinants of relapse and mortality in a north-eastern area of Brazil

Authors

  • Lisandra Serra Damasceno,

    1. Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
    2. Hospital São José of Infectious Disease, Fortaleza, CE, Brazil
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  • Alberto Novaes Ramos Jr,

    1. Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
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  • Carlos Henrique Alencar,

    1. Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
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  • Maria Vânia Freitas Gonçalves,

    1. Hospital São José of Infectious Disease, Fortaleza, CE, Brazil
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  • Jacó Ricarte Lima de Mesquita,

    1. Hospital São José of Infectious Disease, Fortaleza, CE, Brazil
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  • Anne Taumaturgo Dias Soares,

    1. Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
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  • Anna Gisele Nunes Coutinho,

    1. Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
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  • Carolina Cavalcante Dantas,

    1. Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
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  • Terezinha do Menino Jesus Silva Leitão

    Corresponding author
    1. Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
    2. Hospital São José of Infectious Disease, Fortaleza, CE, Brazil
    • Correspondence: T. M. J. Silva Leitão, Department of Community Health, School of Medicine, Federal University of Ceará, Rua Professor Costa Mendes, 1608, 5° andar, Rodolfo Teófilo, CEP: 60430-140, Fortaleza, CE, Brazil.

      Tel.: 55-85-33668044. Fax: 55-85-33668050.

      E-mail: tsilva@ufc.br

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Summary

Many relapses and deaths resulting from disseminated histoplasmosis (DH) in acquired immunodeficiency syndrome (AIDS) patients have been observed in an endemic area in north-eastern Brazil. The objective of this study was to evaluate the risk factors associated with the clinical outcomes of DH/AIDS coinfection in patients from the state of Ceará, Brazil. A retrospective cohort of AIDS patients, after their hospital discharge due to first DH episode in the period 2002–2008, was followed until December 31, 2010, to investigate the factors associated with relapse and mortality. A total of 145 patients were evaluated in the study. Thirty patients (23.3%) relapsed and the overall mortality was 30.2%. The following variables were significantly (P < 0.05) associated with relapse and overall mortality (univariate analysis): non-adherence to highly active antiretroviral therapy (HAART), irregular use of an antifungal, non-recovery of the CD4+ count and having AIDS before DH; histoplasmosis relapse was also significantly associated with mortality. In the multivariate analysis, non-adherence to HAART was the independent risk factor that was associated with both relapse (Adj OR = 6.28) and overall mortality (Adj OR = 8.03); efavirenz usage was discovered to be significant only for the overall mortality rate (Adj OR = 4.50). Adherence to HAART was the most important variable that influenced the outcomes in this specific population.

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