Centre d'Investigation Clinique 1424 Antilles-Guyane, Inserm, Centre Hospitalier de Cayenne, Cayenne, France; Equipe EA3593, Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, Cayenne, France.
Centre d'Investigation Clinique 1424 Antilles-Guyane, Inserm, Centre Hospitalier de Cayenne, Cayenne, France.
Lancet Infect Dis. 2018 Oct;18(10):1150-1159. doi: 10.1016/S1473-3099(18)30354-2. Epub 2018 Aug 23.
Fungal infections remain a major contributor to the opportunistic infections that affect people living with HIV. Among them, histoplasmosis is considered neglected, often being misdiagnosed as tuberculosis, and is responsible for numerous deaths in Latin America. The objective of this study was to estimate the burden of HIV-associated histoplasmosis compared with tuberculosis in Latin American countries.
For this modelling study, we estimated prevalence of previous exposure to Histoplasma capsulatum, HIV-associated histoplasmosis annual incidence, and number of deaths in 2012 in Latin American countries based on historical histoplasmin skin test studies in the general population, with an antigen dilution level of more than 1/10. Studies were identified in a literature search. Data on HIV-associated tuberculosis were extracted from the WHO notifications and outcomes tables and data on people living with HIV were extracted from the UNAIDS report for the year 2012. We systematically propagated uncertainty throughout all the steps of the estimation process.
Among 1310 articles identified as of June 1, 2015, 24 articles were included in the study, representing 129 histoplasmin skin test studies led in the general population of Latin American countries. For the year 2012, we estimated a range of 6710 (95% CI 5680-7867) to 15 657 (13 254-18 357) cases of symptomatic HIV-associated histoplasmosis in Latin America. Hotspot areas for histoplasmosis prevalence (>30%) and incidence (>1·5 cases per 100 people living with HIV) were Central America, the northernmost part of South America, and Argentina. According to realistic scenarios, we estimated a range of 671 (95% CI 568-787) to 9394 (7952-11 014) deaths related to histoplasmosis, compared with 5062 (3777-6405) deaths related to tuberculosis reported in Latin America.
Our estimates of histoplasmosis incidence and deaths are high and consistent with published data. For the first time, the burden of histoplasmosis is estimated to be equivalent in incidence and even higher in deaths when compared with tuberculosis among people living with HIV in Latin America.
None.
真菌感染仍是导致艾滋病毒感染者发生机会性感染的主要原因之一。其中，组织胞浆菌病被认为是被忽视的疾病，常被误诊为肺结核，并且在拉丁美洲造成了大量死亡。本研究的目的是估计与肺结核相比，拉丁美洲国家艾滋病毒相关组织胞浆菌病的负担。
在这项建模研究中，我们根据历史上针对一般人群的组织胞浆菌素皮肤试验研究（抗原稀释度超过 1/10），估计了 2012 年拉丁美洲国家中既往接触荚膜组织胞浆菌的流行率、艾滋病毒相关组织胞浆菌病的年发病率和死亡人数。通过文献检索确定了研究。从世界卫生组织的报告和结果表中提取了与艾滋病毒相关的肺结核数据，并从 2012 年联合国艾滋病规划署的报告中提取了艾滋病毒感染者的数据。我们在整个估计过程的所有步骤中系统地传播了不确定性。
截至 2015 年 6 月 1 日，共检索到 1310 篇文章，其中 24 篇文章被纳入研究，代表了在拉丁美洲国家的一般人群中进行的 129 项组织胞浆菌素皮肤试验研究。我们估计 2012 年拉丁美洲有 6710 例（95%CI 5680-7867）至 15657 例（13254-18357）有症状的艾滋病毒相关组织胞浆菌病病例。组织胞浆菌病流行率（>30%）和发病率（>1.5 例/每 100 名艾滋病毒感染者）较高的热点地区包括中美洲、南美洲最北部和阿根廷。根据现实情况，我们估计相关的组织胞浆菌病死亡人数为 671（95%CI 568-787）至 9394（7952-11014）例，而拉丁美洲报告的与肺结核相关的死亡人数为 5062（3777-6405）例。
我们对组织胞浆菌病发病率和死亡人数的估计值较高，与已发表的数据一致。这是首次估计，与拉丁美洲艾滋病毒感染者中的肺结核相比，组织胞浆菌病的发病率和死亡率相当，甚至更高。
无。
