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Paracoccidioidomycosis in Patients Infected with and Not Infected with Human Immunodeficiency Virus: A Case-Control Study

Epidemiologic and clinical data for 53 patients with paracoccidioidomycosis and co-infected with human immunodeficiency virus (HIV) (cases) were compared with those for 106 patients with endemic paracoccidioidomycosis (controls). The prevalence of Paracoccidioides brasiliensis co-infection was estimated in 1.4% in cases of acquired immunodeficiency syndrome (AIDS). Patients co-infected with HIV were younger, less involved in agricultural occupations; 83.7% had CD4+ cell count < 200 cells/µL. Paracoccidioidomycosis in co-infected patients usually showed a rapid progression, with more fever, frequent involvement of the lungs, and multiple extrapulmonary lesions. The response to antifungal therapy and deaths caused by paracoccidioidomycosis were similar in the two patient groups, but late relapses were more common in co-infected cases. Paracoccidioidomycosis in HIV-infected patients shows epidemiologic and clinical characteristics differing from those of the endemic disease and should be considered an AIDS-defining opportunistic infection in Latin America.

Received April 28, 2008. Accepted for publication November 28, 2008.

Acknowledgments: We thank Lúcia Helena Vitali for technical assistance; Drs. Gleusa de Castro, Maria Janete Moya, Marta Peinado, and Jeova Keny Collares for professional support; and Viviane Cunha Cardoso and Edson Zangiacomi Martinez for assistance in performing statistical analysis.

Financial support: This study was supported by the Brazilian National Ministry of Health (Unidade de Pesquisa e Desenvolvimento Tecnológico) Research and Technological Development Unit)/ National STD/AIDS Program, and the Fundação de Apoio ao Ensino, Pesquisa e Assistência of the Hospital das Clínicas, Faculty of Medicine of Ribeirão Preto, University of São Paulo.

Disclosure: None of the authors have any conflicts of interest.

^* Address correspondence to Roberto Martinez, Divisão de Moléstias Infecciosas e Tropicais, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Avenida Bandeirantes 3900, 14049-900, Ribeirão Preto, SP, Brazil. E-mail: rmartine{at}fmrp.usp.br

Authors’ addresses: Karen M. Loro Morejón, Departamento de Clínica Médica, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, SP, Avenida Bandeirantes 3900, 14048-900, Ribeirão Preto, SP, Brazil, E-mail: karenmorejon{at}uol.com.br. Alcyone Artioli Machado and Roberto Martinez, Divisão de Moléstias Infecciosas e Tropicais, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Avenida Bandeirantes 3900, 14049-900, Ribeirão Preto, SP, Brazil, E-mails: aamachado{at}fmrp.usp.br and rmartine{at}fmrp.usp.br.

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