Perez Freddy, Caceres Diego H, Ford Nathan, Ravasi Giovanni, Gomez Beatriz L, Pasqualotto Alessandro C, Hine Paul, Adenis Antoine A, Nacher Mathieu, Chiller Tom, Baddley John
HIV, Hepatitis, Tuberculosis and Sexually Transmitted Infections Unit, Communicable Diseases and Environmental Determinants of Health Department, Pan American Health Organization, Washington, DC 20037, USA.
Mycotic Diseases Branch, United States Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
J Fungi (Basel). 2021 Feb 12;7(2):134. doi: 10.3390/jof7020134.
Histoplasmosis is a frequent fungal opportunistic infection in people living with HIV (PLHIV), associated every year to a total of 5% to 15% of AIDS-related deaths among this population. In 2020, the first global guidelines for diagnosing and managing disseminated histoplasmosis among PLHIV was published. This document recommends (1) detection of circulating antigens as the recommended laboratory assay to diagnose histoplasmosis among PLHIV; (2) the use of liposomal amphotericin for induction therapy in severe or moderately severe disease, followed by a maintenance therapy with itraconazole for 12 months; a shorter maintenance therapy could be considered if the patient is clinically stable and if immune status has improved; (3) antiretroviral therapy initiation as soon as possible among patients with histoplasmosis without involvement of central nervous system; and (4) that for the treatment of co-infection with histoplasmosis and tuberculosis (TB), treatment of TB should be initiated according to the World Health Organization treatment guidelines. Appropriate health education of providers, supportive supervision, and policy guidance for the care of PLHIV are required.
组织胞浆菌病是艾滋病毒感染者（PLHIV）中常见的机会性真菌感染，每年导致该人群中5%至15%的艾滋病相关死亡。2020年，首个关于诊断和管理PLHIV播散性组织胞浆菌病的全球指南发布。该文件建议：（1）检测循环抗原作为诊断PLHIV组织胞浆菌病的推荐实验室检测方法；（2）对于重度或中度重度疾病，使用脂质体两性霉素进行诱导治疗，随后用伊曲康唑进行12个月的维持治疗；如果患者临床稳定且免疫状态有所改善，可考虑缩短维持治疗时间；（3）在未累及中枢神经系统的组织胞浆菌病患者中尽快启动抗逆转录病毒治疗；（4）对于组织胞浆菌病和结核病合并感染的治疗，应根据世界卫生组织治疗指南启动结核病治疗。需要对医护人员进行适当的健康教育、提供支持性监督以及为PLHIV护理提供政策指导。
