Histoplasma Antigenuria Prevalence in Patients With Advanced HIV Disease in Côte d'Ivoire: A Prospective Trial Ancillary Study.

BACKGROUND

Despite tuberculosis being a well-known concern in patients with advanced human immunodeficiency virus (HIV), the STATIS trial, which focused on its management, highlighted significant mortality rates. Histoplasmosis, a fungal disease endemic in sub-Saharan Africa, presents with similar clinical manifestations as tuberculosis. Therefore, it may be prevalent and potentially responsible for deaths in patients with advanced HIV in this region. We conducted an ancillary study of the ANRS STATIS trial to provide the first prevalence estimates of histoplasmosis among individuals with advanced HIV in Côte d'Ivoire.

METHODS

We analyzed urine samples from patients previously enrolled in the STATIS trial in Côte d'Ivoire. These ambulatory patients with newly diagnosed HIV infection, CD4+ T-cell counts <100/µL, and eligible for antiretroviral therapy (ART) were randomized to receive either systematic or test-guided tuberculosis treatment. We performed Histoplasma antigen enzyme immunoassay on their urine samples.

RESULTS

The prevalence of Histoplasma antigenuria was 68/280 (24.3%; 95% CI: 19.5%-29.8%), including 52/280 (18.6%; 95% CI: 14.3%-23.7%) symptomatic patients. Of 22 tuberculosis cases documented at inclusion, 8 (36.4%) also had Histoplasma antigenuria. In patients who died within the 48-week follow-up, the prevalence of Histoplasma antigenuria was 15/42 (35.7%% 95% CI: 22.0%-52.0%) compared with 22.3% (95% CI: 17.3%-28.2%) in those surviving. These survivors had a higher body mass index, CD4+ T-cell count, and hemoglobin and platelet count than those who died.

CONCLUSIONS

The prevalence of Histoplasma antigenuria was comparable to that of tuberculosis, and histoplasmosis was potentially responsible for preventable deaths. Prospective studies are needed to confirm these findings and promote screening strategies in sub-Saharan Africa.