Chastain Daniel B, Henao-Martínez Andrés F, Franco-Paredes Carlos
University of Georgia College of Pharmacy, 1000 Jefferson Street, Albany, GA, 31701, USA.
University of Colorado Denver, Anschutz Medical Campus, Denver, CO, USA.
Curr Infect Dis Rep. 2017 Aug 22;19(10):36. doi: 10.1007/s11908-017-0592-7.
The goal of this review is to provide an update on the epidemiology, diagnosis, and treatment of opportunistic fungal infections in patients with human immunodeficiency virus (HIV) infection including Cryptococcus spp., Histoplasma spp., Coccidioides spp., and Talaromyces marneffei, formerly Penicillium marneffei.
In many settings, despite increasing roll out of antiretroviral therapy (ART), opportunistic invasive mycoses produce a substantial burden of disease. The prevalence of specific fungal pathogens depends on their endemicity. Viral suppression achieved by greater access to ART and increased the availability of point-of-care testing with rapid diagnostic tests (RDTs) aid to curtail the associated fungi morbidity. RDTs allow earlier screening to preemptively initiate treatment of opportunistic fungal pathogens. Identifying asymptomatic cryptococcal infection before starting ART is crucial in reducing the risk of the immune reconstitution inflammatory syndrome (IRIS). There is an urgent need to decrease the burden of opportunistic invasive fungal infections in individuals with HIV/AIDS through different interventions: (a) continue to expand the deployment of ART to the most affected populations to achieve viral suppression; (b) ensure early diagnosis of fungal pathogen with point-of-care testing;
本综述的目的是提供关于人类免疫缺陷病毒（HIV）感染患者机会性真菌感染的流行病学、诊断和治疗的最新信息，这些感染包括隐球菌属、组织胞浆菌属、球孢子菌属和马尔尼菲篮状菌（原马尔尼菲青霉）。
在许多情况下，尽管抗逆转录病毒疗法（ART）的推广不断增加，但机会性侵袭性真菌病仍造成相当大的疾病负担。特定真菌病原体的流行率取决于其地方性。通过更广泛地获得抗逆转录病毒疗法实现病毒抑制，并增加即时检验（POCT）与快速诊断测试（RDT）的可用性，有助于减少相关真菌病的发病率。快速诊断测试允许早期筛查，以便对机会性真菌病原体进行预防性治疗。在开始抗逆转录病毒治疗之前识别无症状隐球菌感染对于降低免疫重建炎症综合征（IRIS）的风险至关重要。迫切需要通过不同干预措施减轻HIV/AIDS患者机会性侵袭性真菌感染的负担：（a）继续将抗逆转录病毒疗法扩大应用于受影响最严重的人群以实现病毒抑制；（b）通过即时检验确保真菌病原体的早期诊断；
