Invasive Fungal Infections in Persons Living with HIV in an Amazonian Context: French Guiana, 2009–2019

Although the burden of histoplasmosis in patients with advanced HIV has been the focus of detailed estimations, knowledge about invasive fungal infections in patients living with HIV in an Amazonian context is somewhat scattered. Our goal was thus to adopt a broader view integrating all invasive fungal infections diagnosed over a decade in French Guiana. All patients hospitalized at Cayenne hospital from 1 January 2009 to 31 December 2018 with a proven diagnosis of invasive fungal infection were included (N = 227). Histoplasmosis was the most common (48.2%), followed by Cryptococcus infection (26.3%), and pneumocystosis (12.5%). For cryptococcal infection, there was a discordance between the actual diagnosis of cryptococcal meningitis n = (26) and the isolated presence of antigen in the serum (n = 46). Among the latter when the information was available (n = 34), 21(65.6%) were treated with antifungals but not coded as cryptococcocosis. Most fungal infections were simultaneous to the discovery of HIV (38%) and were the AIDS-defining event (66%). The proportion of major invasive fungal infections appeared to remain stable over the course of the study, with a clear predominance of documented H. capsulatum infections. Until now, the focus of attention has been histoplasmosis, but such attention should not overshadow other less-studied invasive fungal infections.

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Cytomegalovirus Viremia Associated With Increased Mortality in Cryptococcal Meningitis in Sub-Saharan Africa

Clinical Infectious Diseases ◽

10.1093/cid/ciz864 ◽

2019 ◽

Vol 71 (3) ◽

pp. 525-531 ◽

Cited By ~ 1

Author(s):

Caleb Skipper ◽

Mark R Schleiss ◽

Ananta S Bangdiwala ◽

Nelmary Hernandez-Alvarado ◽

Kabanda Taseera ◽

...

Keyword(s):

Cryptococcal Meningitis ◽

Opportunistic Infections ◽

Survival Rates ◽

Hazard Ratio ◽

Sub Saharan Africa ◽

Persons Living With Hiv ◽

Median Plasma ◽

Sub Saharan ◽

Immunodeficiency Syndrome ◽

Living With Hiv

Abstract Background Cryptococcal meningitis and tuberculosis are both important causes of death in persons with advanced human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). Cytomegalovirus (CMV) viremia may be associated with increased mortality in persons living with HIV who have tuberculosis. It is unknown whether concurrent CMV viremia is associated with mortality in other AIDS-related opportunistic infections. Methods We prospectively enrolled Ugandans living with HIV who had cryptococcal meningitis from 2010–2012. Subsequently, we analyzed stored baseline plasma samples from 111 subjects for CMV DNA. We compared 10-week survival rates among those with and without CMV viremia. Results Of 111 participants, 52% (58/111) had detectable CMV DNA (median plasma viral load 498 IU/mL, interquartile range [IQR] 259–2390). All samples tested were positive on immunoglobin G serology. The median CD4+ T cell count was 19 cells/µL (IQR 9–70) and did not differ by the presence of CMV viremia (P = .47). The 10-week mortality rates were 40% (23/58) in those with CMV viremia and 21% (11/53) in those without CMV viremia (hazard ratio 2.19, 95% confidence interval [CI] 1.07–4.49; P = .03), which remained significant after a multivariate adjustment for known risk factors of mortality (adjusted hazard ratio 3.25, 95% CI 1.49–7.10; P = .003). Serum and cerebrospinal fluid cytokine levels were generally similar and cryptococcal antigen-specific immune stimulation responses did not differ between groups. Conclusions Half of persons with advanced AIDS and cryptococcal meningitis had detectable CMV viremia. CMV viremia was associated with an over 2-fold higher mortality rate. It remains unclear whether CMV viremia in severely immunocompromised persons with cryptococcal meningitis contributes directly to this mortality or may reflect an underlying immune dysfunction (ie, cause vs effect). Clinical Trials Registration NCT01075152.

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Temporal trends of cutaneo-mucous histoplasmosis in persons living with HIV in French Guiana: Early diagnosis defuses South American strain dermotropism

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0008663 ◽

2020 ◽

Vol 14 (10) ◽

pp. e0008663 ◽

Cited By ~ 1

Author(s):

Sophie Morote ◽

Mathieu Nacher ◽

Romain Blaizot ◽

Balthazar Ntab ◽

Denis Blanchet ◽

...

Keyword(s):

Early Diagnosis ◽

French Guiana ◽

Temporal Trends ◽

South American ◽

Persons Living With Hiv ◽

American Strain ◽

Living With Hiv

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Faculty Opinions recommendation of Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1158467.620153 ◽

2009 ◽

Author(s):

Arturo Casadevall

Keyword(s):

Cryptococcal Meningitis ◽

Global Burden ◽

Persons Living With Hiv ◽

Living With Hiv ◽

Hiv Aids

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Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS

AIDS ◽

10.1097/qad.0b013e328322ffac ◽

2009 ◽

Vol 23 (4) ◽

pp. 525-530 ◽

Cited By ~ 1343

Author(s):

Benjamin J Park ◽

Kathleen A Wannemuehler ◽

Barbara J Marston ◽

Nelesh Govender ◽

Peter G Pappas ◽

...

Keyword(s):

Cryptococcal Meningitis ◽

Global Burden ◽

Persons Living With Hiv ◽

Living With Hiv ◽

Hiv Aids

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The effect of sertraline on depression and associations with persistent depression in survivors of HIV-related cryptococcal meningitis

Wellcome Open Research ◽

10.12688/wellcomeopenres.16363.1 ◽

2021 ◽

Vol 6 ◽

pp. 45

Author(s):

Sarah M. Lofgren ◽

Sruti S. Velamakanni ◽

Katherine Huppler Hullsiek ◽

Ananta S. Bangdiwala ◽

Alice Namudde ◽

...

Keyword(s):

Clinical Trial ◽

Cryptococcal Meningitis ◽

Depression Scale ◽

Severe Depression ◽

Epidemiologic Studies ◽

Persons Living With Hiv ◽

Persistent Depression ◽

Living With Hiv ◽

The Relationship ◽

Modest Reduction

Background: Depression is a risk factor for worse outcomes in persons living with HIV/AIDS and has a prevalence more than three times as high as in the general population. Despite this, there are few randomized studies of antidepressants in HIV-infected Africans. Methods: We enrolled 460 HIV-infected Africans with cryptococcal meningitis into a randomized clinical trial of adjunctive sertraline vs placebo (2015-2017). We defined depression using depression using a Center for Epidemiologic Studies Depression Scale (CES-D) score of >15, and severe depression as >26 at one and three months after meningitis diagnosis and initiation of treatment.We evaluated the relationship between sertraline and depression, as well as associations with persistent depression, at three months. Results: At one- and three-months post meningitis diagnosis, 62% (108/174) and 44% (74/169) of all subjects had depression (CES>15), respectively. At three months, sertraline-treated subjects had consistent risk for depression as placebo-treated subjects but were significantly less likely to have severe depression (CES>26) (OR 0.335; 95%CI, 0.130-0.865). Of those with depression at one month, sertraline-treated subjects were less likely than placebo-treated subjects to be depressed at three months (p=0.05). Sertraline was the only factor we found significant in predicting persistent depression at three months among those who had depression at one month. Conclusions: Depression is highly prevalent in HIV-infected persons who have survived cryptococcal meningitis. We found that sertraline is associated with a modest reduction in depression in those with depression at baseline and a significant decrease in severe depression.

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Comparison of Disseminated Histoplasmosis with and without Cutaneo-Mucous Lesions in Persons Living with HIV in French Guiana

Journal of Fungi ◽

10.3390/jof6030133 ◽

2020 ◽

Vol 6 (3) ◽

pp. 133

Author(s):

Sophie Morote ◽

Mathieu Nacher ◽

Romain Blaizot ◽

Balthazar Ntab ◽

Denis Blanchet ◽

...

Keyword(s):

French Guiana ◽

Opportunistic Infections ◽

Significant Risk ◽

Early Death ◽

Fungal Culture ◽

Direct Examination ◽

Disseminated Histoplasmosis ◽

Persons Living With Hiv ◽

Living With Hiv ◽

Incident Cases

Introduction: Histoplasmosis is the main opportunistic infection and cause of death in HIV-infected persons living with HIV in French Guiana and probably in most of Latin America. The objective of the present study was to compare cutaneomucous histoplasmosis to non-cutaneomucous histoplasmosis in French Guiana. Methods: Between 1981 and 2014 AIDS-related disseminated histoplasmosis patients followed in the three hospitals of French Guiana were retrospectively studied. Only proven incident cases of histoplasmosis, either by pathology and/or mycological analysis, were considered. Mucocutaneous histoplasmosis was ascertained by a positive mucosal or cutaneous biopsy. Results: Thirty-one patients had mucocutaneous lesions, and 318 had no mucocutaneous lesions. Patients with cutaneomucous lesions were more likely to have had prior opportunistic infections (35.5%) than those who did not have cutaneomucous lesions (19.5%). They were more likely to be very severely immunocompromised (CD4 count < 50) (90.3% versus 62.8%) and less likely to have digestive signs (32.3% versus 74.1%) and superficial adenopathies (29% versus 50.2%) than those without cutaneomucous lesions. In terms of simple biological examinations, patients with cutaneomucous lesions had fewer signs of cholestasis. The diagnosis was significantly more likely to be performed by direct examination and pathology in those with cutaneomucous lesions than in those without such lesions. On the contrary, patients with cutaneomucous lesions were less likely to be diagnosed by fungal culture than those without cutaneomucous lesions. There was a greater but non-significant risk of early death in those with cutaneomucous lesions relative to those without (OR = 2.28 (95%CI = 0.83–5.7), p = 0.056. Conclusions: Mucocutaneous forms were associated with more profound immunosuppression and perhaps risk of early death. They are easily accessible for diagnosis.

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