Histoplasma antigenuria prevalence in patients with advanced HIV disease in Côte d'Ivoire: a prospective trial ancillary study.

Abstract

BACKGROUND Despite tuberculosis being a well-known concern in advanced HIV patients, 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 of tuberculosis. Therefore, it may be prevalent and potentially responsible for deaths in advanced HIV patients in this region. We conducted an ancillary study of the 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 to ART were randomized to receive either systematic or test-guided tuberculosis treatment. We performed Histoplasma Antigen Enzyme Immunoassay (EIA) 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, 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.