Prevalence of Histoplasmosis among Persons with Advanced HIV Disease, Nigeria

This is the authors' abstract. We don't add key points for this paper.

H istoplasmosis, an invasive fungal infection en- demic in the Americas, Africa, and Asia, with a few cases reported among immigrants to Europe, was classified as an AIDS-defining disease in 1987 (1,2).Incidence of disseminated histoplasmosis is 5%-25% in persons with advanced HIV disease (AHD; World Health Organization [WHO]-preferred term for AIDS), and according to recent data from South America, mortality rates are similar to those for tuberculosis among this patient group (3,4).In Latin America, high prevalence rates have been reported for disseminated histoplasmosis in AHD populations in Brazil (22%; 123/570) and Mexico (30%; 85/288) (5,6).Histoplasmosis is the most common AIDS-defining infection in Guatemala, more common than tuberculosis (7).In a recent study from Cameroon, 26% (36/138) of HIV patients had Histoplasma antigen in their urine regardless of CD4 count; a 2015 report indicated a 13% (7/56) prevalence in the AHD population (8,9).WHO in 2020 published its first guidelines for disseminated histoplasmosis among persons with AHD, including recommendations for diagnosis (10).WHO and the US President's Emergency Plan for AIDS Relief (PEPFAR) recommend providing differentiated care tailored to the unique needs of different HIV patient populations.Screening, treatment, and prophylaxis for major opportunistic infections is recommended for AHD (10).These key evidence-based interventions reduce illness and death among this clinically unstable population.Nigeria recently adopted a package of care for AHD that includes histoplasmosis screening, which has yet to be implemented.Nigeria has the 7th highest global tuberculosis Prevalence of Histoplasmosis among Persons with Advanced HIV Disease, Nigeria