Primary Prophylaxis of Disseminated Histoplasmosis in HIV Patients in French Guiana: Arguments for Cost Effectiveness

Mathieu Nacher Centre d'Investigation Clinique Epidémiologie Clinique Antilles Guyane (Inserm/DGOS CIE 802), Centre Hospitalier de Cayenne, French Guiana; Epidemiologie Parasitoses et Mycoses Tropicales, EA 3593, Université Antilles Guyane, Cayenne, French Guiana; Coordination Regionale de lutte contre le VIH, Centre Hospitalier de Cayenne, French Guiana; Centre Hospitalier de l’Ouest Guyanais, Saint Laurent du Maroni, French Guiana; Laboratoire Hospitalo Universitaire de Parasitologie Mycologie, Centre Hospitalier de Cayenne, French Guiana; Service de Dermatologie, Centre Hospitalier de Cayenne, French Guiana

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Antoine Adenis Centre d'Investigation Clinique Epidémiologie Clinique Antilles Guyane (Inserm/DGOS CIE 802), Centre Hospitalier de Cayenne, French Guiana; Epidemiologie Parasitoses et Mycoses Tropicales, EA 3593, Université Antilles Guyane, Cayenne, French Guiana; Coordination Regionale de lutte contre le VIH, Centre Hospitalier de Cayenne, French Guiana; Centre Hospitalier de l’Ouest Guyanais, Saint Laurent du Maroni, French Guiana; Laboratoire Hospitalo Universitaire de Parasitologie Mycologie, Centre Hospitalier de Cayenne, French Guiana; Service de Dermatologie, Centre Hospitalier de Cayenne, French Guiana

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Celia Basurko Centre d'Investigation Clinique Epidémiologie Clinique Antilles Guyane (Inserm/DGOS CIE 802), Centre Hospitalier de Cayenne, French Guiana; Epidemiologie Parasitoses et Mycoses Tropicales, EA 3593, Université Antilles Guyane, Cayenne, French Guiana; Coordination Regionale de lutte contre le VIH, Centre Hospitalier de Cayenne, French Guiana; Centre Hospitalier de l’Ouest Guyanais, Saint Laurent du Maroni, French Guiana; Laboratoire Hospitalo Universitaire de Parasitologie Mycologie, Centre Hospitalier de Cayenne, French Guiana; Service de Dermatologie, Centre Hospitalier de Cayenne, French Guiana

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Vincent Vantilcke Centre d'Investigation Clinique Epidémiologie Clinique Antilles Guyane (Inserm/DGOS CIE 802), Centre Hospitalier de Cayenne, French Guiana; Epidemiologie Parasitoses et Mycoses Tropicales, EA 3593, Université Antilles Guyane, Cayenne, French Guiana; Coordination Regionale de lutte contre le VIH, Centre Hospitalier de Cayenne, French Guiana; Centre Hospitalier de l’Ouest Guyanais, Saint Laurent du Maroni, French Guiana; Laboratoire Hospitalo Universitaire de Parasitologie Mycologie, Centre Hospitalier de Cayenne, French Guiana; Service de Dermatologie, Centre Hospitalier de Cayenne, French Guiana

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Denis Blanchet Centre d'Investigation Clinique Epidémiologie Clinique Antilles Guyane (Inserm/DGOS CIE 802), Centre Hospitalier de Cayenne, French Guiana; Epidemiologie Parasitoses et Mycoses Tropicales, EA 3593, Université Antilles Guyane, Cayenne, French Guiana; Coordination Regionale de lutte contre le VIH, Centre Hospitalier de Cayenne, French Guiana; Centre Hospitalier de l’Ouest Guyanais, Saint Laurent du Maroni, French Guiana; Laboratoire Hospitalo Universitaire de Parasitologie Mycologie, Centre Hospitalier de Cayenne, French Guiana; Service de Dermatologie, Centre Hospitalier de Cayenne, French Guiana

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Christine Aznar Centre d'Investigation Clinique Epidémiologie Clinique Antilles Guyane (Inserm/DGOS CIE 802), Centre Hospitalier de Cayenne, French Guiana; Epidemiologie Parasitoses et Mycoses Tropicales, EA 3593, Université Antilles Guyane, Cayenne, French Guiana; Coordination Regionale de lutte contre le VIH, Centre Hospitalier de Cayenne, French Guiana; Centre Hospitalier de l’Ouest Guyanais, Saint Laurent du Maroni, French Guiana; Laboratoire Hospitalo Universitaire de Parasitologie Mycologie, Centre Hospitalier de Cayenne, French Guiana; Service de Dermatologie, Centre Hospitalier de Cayenne, French Guiana

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Bernard Carme Centre d'Investigation Clinique Epidémiologie Clinique Antilles Guyane (Inserm/DGOS CIE 802), Centre Hospitalier de Cayenne, French Guiana; Epidemiologie Parasitoses et Mycoses Tropicales, EA 3593, Université Antilles Guyane, Cayenne, French Guiana; Coordination Regionale de lutte contre le VIH, Centre Hospitalier de Cayenne, French Guiana; Centre Hospitalier de l’Ouest Guyanais, Saint Laurent du Maroni, French Guiana; Laboratoire Hospitalo Universitaire de Parasitologie Mycologie, Centre Hospitalier de Cayenne, French Guiana; Service de Dermatologie, Centre Hospitalier de Cayenne, French Guiana

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Pierre Couppié Centre d'Investigation Clinique Epidémiologie Clinique Antilles Guyane (Inserm/DGOS CIE 802), Centre Hospitalier de Cayenne, French Guiana; Epidemiologie Parasitoses et Mycoses Tropicales, EA 3593, Université Antilles Guyane, Cayenne, French Guiana; Coordination Regionale de lutte contre le VIH, Centre Hospitalier de Cayenne, French Guiana; Centre Hospitalier de l’Ouest Guyanais, Saint Laurent du Maroni, French Guiana; Laboratoire Hospitalo Universitaire de Parasitologie Mycologie, Centre Hospitalier de Cayenne, French Guiana; Service de Dermatologie, Centre Hospitalier de Cayenne, French Guiana

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Histoplasmosis is the first cause of acquired immunodeficiency syndrome (AIDS) and AIDS-related deaths in French Guiana. Cohort data were used to determine whether primary prophylaxis with 100 mg itraconazole for patients with CD4 counts < 150/mm3 was cost-effective with different scenarios. For a scenario where 12% of patients died, 60% were aware of their human immunodeficiency virus (HIV) infection and adherence was only 50%, primary prophylaxis would prevent 1 death and 9 cases of histoplasmosis for a cost of 36,792 Euros per averted death, 1,533 per life-year saved, 4,415 Euros per averted case, when only counting the costs of itraconazole prophylaxis. Taking into account the total costs of hospitalization showed that primary prophylaxis would allow a savings of 185,178 Euros per year. Even in a scenario of low adherence, primary prophylaxis would be cost-effective in French Guiana, and presumably in the rest of the Guianas and the Amazon.

Author Notes

* Address correspondence to Mathieu Nacher, CH Cayenne, rue des flamboyants, Cayenne 97300. E-mail: mathieu.nacher@ch-cayenne.fr

Authors' addresses: Mathieu Nacher and Antoine Adenis, Cayenne General Hospital - Centre d'Investigation Clinique Epidémiologie Clinique Antilles Guyane, Cayenne, French Guiana, E-mails: Mathieu.nacher@ch-cayenne.fr and antoine.adenis@ch-cayenne.fr. Celia Basurko, Centre Hospitalier de Cayenne - Centre d'Investigation Clinique, Epidémiologie Clinique Antilles Guyane, Cayenne, French Guiana, E-mail: celia.basurko@ch-cayenne.fr. Vincent Vantilcke, Centre Hospitalier de l’Ouest Guyanais - Service de Médecine, Saint Laurent du Maroni, French Guiana, E-mail: v.vantilcke@ch-ouestguyane.fr. Denis Blanchet, Centre Hospitalier de Cayenne - Laboratoire Hospitalo Universitaire de Parasitologie Mycology, Cayenne, French Guiana, E-mail: denis.blanchet@ch-cayenne.fr. Christine Aznar, Centre Hospitalier de Cayenne - Service Hospitalo Universitaire de Parasitologie Mycologie, Cayenne, French Guiana, E-mail: christine.aznar@ch-cayenne.fr. Bernard Carme, Centre d'Investigation Clinique épidémiologie Clinique Antilles Guyane, CIE INSERM 802 - Pole de Guyane, Centre Hospitalier de Cayenne, Cayenne, French Guiana, E-mail: bernard.carme@ch-cayenne.fr. Pierre Couppié, Universite des Antilles et de la Guyane - Equipe EA 3593, Epidemiologie des Parasitoses et Mycoses Tropicales, Cayenne, French Guiana, E-mail: couppie.pierre@voila.fr.

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