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Imported Acquired Immunodeficiency Syndrome–Related Histoplasmosis in Metropolitan France: A Comparison of Pre–Highly Active Anti-Retroviral Therapy and Highly Active Anti-Retroviral Therapy Eras

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  • Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycologie et Antifongiques, Paris, France; Centre National de la Recherche Scientifique Unité de Raccordement des Abonnés 3012, Paris, France; Département de Biostatistiques, Hopital Necker-Enfants Malades, Paris, France; Service de Médecine Interne, Centre Hospitalier Universitaire Bichat, Paris, France; Université Paris Descartes, Hopital Necker-Enfants Malades, Centre d'Infectiologie Necker Pasteur, Paris, France
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Histoplasma capsulatum var. capsulatum infection is rare outside disease-endemic areas. Clinical presentation and outcome of acquired immunodeficiency syndrome–related histoplasmosis are unknown in non-endemic areas with wide access to highly active anti-retroviral therapy (HAART). Retrospective analysis of cases recorded at the French National Reference Center for Mycoses and Antifungals during two decades: pre-HAART (1985–1994) and HAART (1997–2006). Clinical features and outcome of all adults with proven acquired immunodeficiency syndrome–related histoplasmosis were compared between the two periods. One hundred four patients were included (40 during the pre-HAART era and 64 during the HAART era). Diagnosis was established a mean of 62 days after onset of symptoms. One-year overall mortality rates decreased from 53% (pre-HAART era) to 22% (HAART era). Diagnosis during the pre-HAART era and an older age were the only independent factors associated with death. Histoplasmosis is a rare invasive fungal infection outside disease-endemic areas. Its prognosis improved significantly during the HAART era.

Author Notes

*Address correspondence to Olivier Lortholary, Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycologie et Antifongiques and Centre National de la Recherche Scientifique Unité de Raccordement des Abonnés 3012, 25–28 Rue du Docteur Roux, 75015 Paris, France. E-mail: olortho@pasteur.fr

Authors' addresses: Vincent Peigne, Unité de Mycologie Moléculaire, Centre National de Référence Mycologie et Antifongiques Institut Pasteur, 25–28 Rue du Docteur Roux, 75015 Paris, France (present address: Service de Réanimation Médicale, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015 Paris, France), E-mail: vincent.peigne@egp.aphp.fr. Françoise Dromer, Unité de Mycologie Moléculaire, Centre National de Référence Mycologie et Antifongiques, Centre National de la Recherche Scientifique Unité de Raccordement des Abonnés 3012, Institut Pasteur, 25–28 Rue du Docteur Roux, 75015 Paris, France, E-mail: francoise.dromer@pasteur.fr. Caroline Elie, Département de Biostatistiques, Hôpital Necker-Enfants Malades, 149 Rue de Sèvres, 75015 Paris, France, E-mail: caroline.elie@parisdescartes.fr. Olivier Lidove, Service de Médecine Interne, Centre Hospitalier Universitaire Bichat, 48 Rue Henri Huchard, 75018 Paris, France, E-mail: olivier.lidove@bch.ap-hop-paris.fr. Olivier Lortholary, Unité de Mycologie Moléculaire, Centre National de Référence Mycologie et Antifongiques, Centre Hospitalier Universitaire 3012, Institut Pasteur, 25–28 Rue du Docteur Roux, 75015 Paris, France and Université Paris Descartes, Hopital Necker-Enfants Malades, Centre d'Infectiologie Necker Pasteur, 149 Rue de Sèvres, 75015 Paris, France, E-mail: olortho@pasteur.fr.

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