Coccidioidomycosis in patients with HIV-1 infection in the era of potent antiretroviral therapy

Fares Y. Masannat, Neil M. Ampel

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Background. Coccidioidomycosis is a common opportunistic infection in human immunodeficiency virus type 1 (HIV-1)-infected individuals living in regions where coccidioidomycosis is endemic. However, there have been no studies on its incidence or clinical expression during the era of potent antiretroviral therapy. Methods. Clinical data were abstracted from the records of all HIV-1-infected patients attending a single clinic in a region where coccidioidomycosis is endemic from January 2003 through May 2008. Additional follow-up was performed through May 2009 for individuals with active coccidioidomycosis. A case-control study was performed that compared all individuals who attended the clinic with individuals who received a diagnosis of coccidioidomycosis. Results. Among 257 HIV-1-infected patients seen over a 64-month period, 29 cases (11.3%) of coccidioidomycosis were identified. Twelve patients (4.7%) received a diagnosis of coccidioidomycosis during the study period (annual incidence, 0.9%). Patients with less severe coccidioidomycosis were significantly more likely to have an undetectable HIV RNA level and to be receiving potent antiretroviral therapy than were those with more severe disease (for both, ). Five patients with coccidioidomycosis received no antifungal therapy, and 11 P < .01 others had antifungal therapy discontinued. All were healthy during follow-up. Patients with coccidioidomycosis had significantly lower CD4 T lymphocyte counts than did control subjects (mean ± standard deviation, 285 ± 42 cells/μL vs 477 ± 21 cells/μL; P = .003) Conclusions. The incidence of symptomatic coccidioidomycosis in the era of potent antiretroviral therapy has decreased, and its clinical expression is less severe than it was before the potent antiretroviral therapy era. Severity of coccidioidomycosis was inversely associated with control of HIV-1 infection.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalClinical Infectious Diseases
Volume50
Issue number1
DOIs
StatePublished - Jan 2010

Fingerprint

Coccidioidomycosis
Virus Diseases
HIV-1
Therapeutics
Incidence
Opportunistic Infections
CD4 Lymphocyte Count
Case-Control Studies

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)

Cite this

Coccidioidomycosis in patients with HIV-1 infection in the era of potent antiretroviral therapy. / Masannat, Fares Y.; Ampel, Neil M.

In: Clinical Infectious Diseases, Vol. 50, No. 1, 01.2010, p. 1-7.

Research output: Contribution to journalArticle

@article{452188b6799a4a01b3bb6ed19f5b494e,
title = "Coccidioidomycosis in patients with HIV-1 infection in the era of potent antiretroviral therapy",
abstract = "Background. Coccidioidomycosis is a common opportunistic infection in human immunodeficiency virus type 1 (HIV-1)-infected individuals living in regions where coccidioidomycosis is endemic. However, there have been no studies on its incidence or clinical expression during the era of potent antiretroviral therapy. Methods. Clinical data were abstracted from the records of all HIV-1-infected patients attending a single clinic in a region where coccidioidomycosis is endemic from January 2003 through May 2008. Additional follow-up was performed through May 2009 for individuals with active coccidioidomycosis. A case-control study was performed that compared all individuals who attended the clinic with individuals who received a diagnosis of coccidioidomycosis. Results. Among 257 HIV-1-infected patients seen over a 64-month period, 29 cases (11.3{\%}) of coccidioidomycosis were identified. Twelve patients (4.7{\%}) received a diagnosis of coccidioidomycosis during the study period (annual incidence, 0.9{\%}). Patients with less severe coccidioidomycosis were significantly more likely to have an undetectable HIV RNA level and to be receiving potent antiretroviral therapy than were those with more severe disease (for both, ). Five patients with coccidioidomycosis received no antifungal therapy, and 11 P < .01 others had antifungal therapy discontinued. All were healthy during follow-up. Patients with coccidioidomycosis had significantly lower CD4 T lymphocyte counts than did control subjects (mean ± standard deviation, 285 ± 42 cells/μL vs 477 ± 21 cells/μL; P = .003) Conclusions. The incidence of symptomatic coccidioidomycosis in the era of potent antiretroviral therapy has decreased, and its clinical expression is less severe than it was before the potent antiretroviral therapy era. Severity of coccidioidomycosis was inversely associated with control of HIV-1 infection.",
author = "Masannat, {Fares Y.} and Ampel, {Neil M.}",
year = "2010",
month = "1",
doi = "10.1086/648719",
language = "English (US)",
volume = "50",
pages = "1--7",
journal = "Clinical Infectious Diseases",
issn = "1058-4838",
publisher = "Oxford University Press",
number = "1",

}

TY - JOUR

T1 - Coccidioidomycosis in patients with HIV-1 infection in the era of potent antiretroviral therapy

AU - Masannat, Fares Y.

AU - Ampel, Neil M.

PY - 2010/1

Y1 - 2010/1

N2 - Background. Coccidioidomycosis is a common opportunistic infection in human immunodeficiency virus type 1 (HIV-1)-infected individuals living in regions where coccidioidomycosis is endemic. However, there have been no studies on its incidence or clinical expression during the era of potent antiretroviral therapy. Methods. Clinical data were abstracted from the records of all HIV-1-infected patients attending a single clinic in a region where coccidioidomycosis is endemic from January 2003 through May 2008. Additional follow-up was performed through May 2009 for individuals with active coccidioidomycosis. A case-control study was performed that compared all individuals who attended the clinic with individuals who received a diagnosis of coccidioidomycosis. Results. Among 257 HIV-1-infected patients seen over a 64-month period, 29 cases (11.3%) of coccidioidomycosis were identified. Twelve patients (4.7%) received a diagnosis of coccidioidomycosis during the study period (annual incidence, 0.9%). Patients with less severe coccidioidomycosis were significantly more likely to have an undetectable HIV RNA level and to be receiving potent antiretroviral therapy than were those with more severe disease (for both, ). Five patients with coccidioidomycosis received no antifungal therapy, and 11 P < .01 others had antifungal therapy discontinued. All were healthy during follow-up. Patients with coccidioidomycosis had significantly lower CD4 T lymphocyte counts than did control subjects (mean ± standard deviation, 285 ± 42 cells/μL vs 477 ± 21 cells/μL; P = .003) Conclusions. The incidence of symptomatic coccidioidomycosis in the era of potent antiretroviral therapy has decreased, and its clinical expression is less severe than it was before the potent antiretroviral therapy era. Severity of coccidioidomycosis was inversely associated with control of HIV-1 infection.

AB - Background. Coccidioidomycosis is a common opportunistic infection in human immunodeficiency virus type 1 (HIV-1)-infected individuals living in regions where coccidioidomycosis is endemic. However, there have been no studies on its incidence or clinical expression during the era of potent antiretroviral therapy. Methods. Clinical data were abstracted from the records of all HIV-1-infected patients attending a single clinic in a region where coccidioidomycosis is endemic from January 2003 through May 2008. Additional follow-up was performed through May 2009 for individuals with active coccidioidomycosis. A case-control study was performed that compared all individuals who attended the clinic with individuals who received a diagnosis of coccidioidomycosis. Results. Among 257 HIV-1-infected patients seen over a 64-month period, 29 cases (11.3%) of coccidioidomycosis were identified. Twelve patients (4.7%) received a diagnosis of coccidioidomycosis during the study period (annual incidence, 0.9%). Patients with less severe coccidioidomycosis were significantly more likely to have an undetectable HIV RNA level and to be receiving potent antiretroviral therapy than were those with more severe disease (for both, ). Five patients with coccidioidomycosis received no antifungal therapy, and 11 P < .01 others had antifungal therapy discontinued. All were healthy during follow-up. Patients with coccidioidomycosis had significantly lower CD4 T lymphocyte counts than did control subjects (mean ± standard deviation, 285 ± 42 cells/μL vs 477 ± 21 cells/μL; P = .003) Conclusions. The incidence of symptomatic coccidioidomycosis in the era of potent antiretroviral therapy has decreased, and its clinical expression is less severe than it was before the potent antiretroviral therapy era. Severity of coccidioidomycosis was inversely associated with control of HIV-1 infection.

UR - http://www.scopus.com/inward/record.url?scp=72049107754&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=72049107754&partnerID=8YFLogxK

U2 - 10.1086/648719

DO - 10.1086/648719

M3 - Article

C2 - 19995218

AN - SCOPUS:72049107754

VL - 50

SP - 1

EP - 7

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

IS - 1

ER -