What is AIDS in the Amazon and the Guianas in the 90-90-90 era?

Adenis, Antoine; Guarmit, Basma; Lucarelli, Aude; Blanchet, Denis; Demar, Magalie; Djossou, Félix; Abboud, Philippe; Epelboin, Loïc; Couppié, Pierre

doi:10.1101/2020.03.13.990473

Cited by 11 publications

(5 citation statements)

References 15 publications

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“…Therefore, some facial and oral alterations can instigate the patient to seek a professional diagnosis of the alteration because they are visually accessible. Diagnosis time consuming and difficult to appropriate treatment can lead histoplasmosis may be killing numerous patients in Latin America (Nacher et al, 2020). The treatment of disseminated histoplasmosis is usually carried out with amphotericin B and itraconazole.…”

Section: Discussionmentioning

confidence: 99%

Seropositive HIV diagnosis after oral histoplasmosis: the importance of multi-professional care in health

Seixas

Spadrizani

Gregorio

et al. 2020

RSD

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Histoplasmosis is a systemic fungal disease, which can manifest with extrapulmonary lesions. Oral lesions are rarely the first manifestation of late histoplasmosis and can represent an important process of immune imbalance. The objective of this work is to present a clinical case of Histoplasmosis with an oral manifestation of a patient who was unaware of her condition with the Human Immunodeficiency Virus (HIV). The patient's main complaint was a painful ulcer in the central region of the tongue present for two months, whose incisional biopsy resulted in the diagnosis of Histoplasmosis. Although referred for medical treatment with an infectologist, the patient had complications resulting from the disease and died after one month. This situation demonstrates the importance of multidisciplinary care in the prevention, diagnosis and treatment of diseases. The correct diagnosis and treatment can be decisive in the prognosis of patients and demonstrates the relevance of the dentist's knowledge about the various systemic diseases that present oral manifestations.

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Section: Discussionmentioning

confidence: 99%

Seropositive HIV diagnosis after oral histoplasmosis: the importance of multi-professional care in health

Seixas

Spadrizani

Gregorio

et al. 2020

RSD

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“…7,8 In this region, disseminated histoplasmosis is the most frequent AIDSdefining illness. 7 Although physicians are prompt to think about the diagnosis in most cases, and direct examination and culture are available, up-to-date antibody and antigen detection tests are still not routinely available and practiced in the CSF of people living with HIV in French Guiana. Few data regarding CNS histoplasmosis in persons living with HIV are available in the Amazon region.…”

Section: Introductionmentioning

confidence: 99%

Histoplasmosis of the Central Nervous System: A Case Series between 1990 and 2019 in French Guiana

Epelboin

Dione

Serris

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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Disseminated histoplasmosis is the most frequent acquired immunodeficiency syndrome–defining illness in French Guiana. Paradoxically, central nervous system (CNS) involvement has been scarcely described. We aimed to identify CNS histoplasmosis in our territory. We conducted an observational, multicentric, descriptive, and retrospective study including patients with proven or probable CNS histoplasmosis according to the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MGS). The study population consisted of patients admitted in one of the hospitals of French Guiana between January 1, 1990 and December 31, 2019. During the study period, 390 cases of HIV-associated histoplasmosis were recorded, in which six of them had CNS infections with Histoplasma capsulatum. The male to female sex ratio was 0.25, and the median age at diagnosis was 37.5 years. The median CD4 count was 42 cells/mm3 ([IQR: 29–60]). All patients had disseminated histoplasmosis. Usual signs of meningitis were observed in three patients and focal signs in four patients. One patient had no neurological signs. The median time between the first cerebral symptoms and diagnosis was 22.4 days (IQR 9.5–36.2). Two patients died within a month after diagnosis. In conclusion, few proven CNS localizations of histoplasmosis were observed on 30-year study in French Guiana. This low proportion suggests that the documentation of CNS involvement is often not ascertained for lack of awareness of this particular presentation, and for lack of rapid and sensitive diagnostic tools.

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“…It is not easy to differentiate them because rapid diagnostic tests for histoplasmosis are lacking in most of Latin America. [1] Histoplasmosis is hard to diagnose because it requires mycological expertise and because fungal growth is slow. Moreover, histoplasmosis is frequently associated with tuberculosis (ranging from 2 to 38% and in most countries >10%) [2].…”

Section: Introductionmentioning

confidence: 99%

HIV patients dying on anti-tuberculosis treatment: are undiagnosed infections still a problem in French Guiana?

Adenis

Abboud

Djossou

et al. 2020

Preprint

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Objective Despite scaling-up testing and antiretroviral treatment in Latin America, advanced HIV remains a significant public health problem. The objective of the present study was look for historical risk factors for death in French Guiana’s HIV cohort taking into account the immunological status, the main opportunistic infections, and their treatment. A retrospective cohort study was conducted on data collected between 1992 and 2008 to identify factors associated with death in a cohort 2323 patients. Results There were 370 deaths for a total 9608 patient-years. Being on tuberculosis treatment was associated with a greater hazard of death. The diagnosis of confirmed tuberculosis, of histoplasmosis, of toxoplasmosis, and pneumocystosis were independently associated with death. Interactions terms between cotrimoxazole treatment and pneumocystosis, or between confirmed tuberculosis and tuberculosis treatment showed a protective treatment-effect. All patients having received anti-tuberculosis treatment (n=347) did not have a final diagnosis of tuberculosis (n=93). For histoplasmosis, 199 patients received antifungal treatment while 141 were diagnosed as having histoplasmosis. The number of patients on anti-tuberculosis drugs was far greater that the number of patients with confirmed tuberculosis, and these patients on treatment without confirmed tuberculosis had a twofold greater risk of dying.

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What is AIDS in the Amazon and the Guianas in the 90-90-90 era?

Abstract: ConclusionsDespite the successes of antiretrovirals, patients presenting with advanced HIV are still common and they are still at risk of dying. Improved diagnosis, and notably systematic screening with appropriate tools are still important areas of potential progress.

Cited by 11 publications

References 15 publications

Seropositive HIV diagnosis after oral histoplasmosis: the importance of multi-professional care in health

Seropositive HIV diagnosis after oral histoplasmosis: the importance of multi-professional care in health

Histoplasmosis of the Central Nervous System: A Case Series between 1990 and 2019 in French Guiana

HIV patients dying on anti-tuberculosis treatment: are undiagnosed infections still a problem in French Guiana?

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