Coccidioidomycosis in Human Immunodeficiency Virus–Infected Persons in Arizona, 1994–1997: Incidence, Risk Factors, and Prevention

Abstract

From 1 January 1995 through 31 June 1997, 153 cases of coccidioidomycosis in human immunodeficiency virus (HIV)-infected persons were identified in Arizona (incidence, 41/1000 persons living with AIDS). A case-control study was conducted to evaluate risk factors for coccidioidomycosis in HIV-infected persons. A case was defined as laboratory-confirmed, incident coccidioidomycosis in a person infected with HIV for > or =3 months, and each case patient had 3 control patients matched by county, age group, sex, HIV/AIDS status, and CD4 lymphocyte count. Multivariable analysis identified black race and a history of oropharyngeal or esophageal candidiasis to be associated with increased risk of coccidioidomycosis; protease inhibitor therapy was associated with a reduced risk. In persons with previous history of oropharyngeal or esophageal candidiasis, having received an azole drug was associated with a reduced risk (odds ratio, 0.4; 95% confidence interval, 0.2-0.9; P=.04). Physicians may need to consider azole chemoprophylaxis for HIV-infected persons who live in areas of endemicity, have CD4 cell counts <200/microL, are black, or have a history of thrush.

Recent Advances in Our Understanding of the Environmental, Epidemiological, Immunological, and Clinical Dimensions of Coccidioidomycosis

“…As described above, the outlook for patients with HIV and coccidioidomycosis has improved significantly in the era of highly active antiretroviral therapy (88,172). For patients with preserved CD4 counts and mild illness, it has been proposed that treatment can follow the guidelines established for patients without HIV infection.…”

Pulmonary infections in HIV-infected patients: an update in the 21st century

“…This is difficult to demonstrate, as the incidence of these infections has not been fully determined [50,113]. The three major endemic fungi are Histoplasma capsulatum, Coccidiodes inmitis and Blastomyces dermatitidis.…”

Update on the Epidemiology of Coccidioidomycosis

“…The contribution of cell-mediated immunity is again illustrated as the risk of coccidioidomycosis infection has been shown to be inversely correlated with CD4 cell counts [36]. Although the incidence of disseminated coccidioidomycosis in HIV positive patients has declined with the advent of combination antiretroviral therapy, conferring protection from disease, a history of candidiasis along with the use of an azole drug was also seen to result in a reduced risk for coccidioidomycosis [37].…”