Abstract
HIV infection associated CD4 depletion is an important defect leading to increased susceptibility to opportunistic as well as endemic fungal infections. Mucosal candidiasis, Pneumocystis jirovecii pneumonia (PJP), and cryptococcal meningoencephalitis were commonest invasive fungal infections identified during early HIV epidemic. Other endemic fungal infections like histoplasmosis and talaromycosis were also increasingly recognized in respective endemic areas after HIV epidemic. Patients with CD4 less than 200/cm3 are at a risk of getting life threatening fungal infections. Understanding of various mycosis in AIDS has improved over last three decades. PJP can be effectively prevented by cotrimoxazole prophylaxis. Advancement in fungal diagnosis and management improved the outcome of patients. Despite this progress in diagnosis and understanding of antifungal therapy, mortality with cryptococcal meningitis is very high especially in sub-Saharan African countries. Access to antiretroviral treatment has improved globally in reducing fungal infection rate. Early initiation of ART dramatically reduces the incidence of opportunistic infections in HIV including mycosis. HIV associated opportunistic and endemic mycosis is discussed in this chapter.
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References
Brown GD, Denning DW, Gow NA, Levitz SM, Netea MG, White TC. Hidden killers: human fungal infections. Sci Transl Med. 2012;4:165rv13.
Armstrong-James D, Meintjes G, Brown GD. A neglected epidemic: fungal infections in HIV/AIDS. Trends Microbiol. 2014;22:120–7.
Antinori S, Nebuloni M, Magni C, et al. Trends in the postmortem diagnosis of opportunistic invasive fungal infections in patients with AIDS: a retrospective study of 1,630 autopsies performed between 1984 and 2002. Am J Clin Pathol. 2009;132:221–7.
Park BJ, Shetty S, Ahlquist A, et al. Long-term follow-up and survival of antiretroviral-naive patients with cryptococcal meningitis in the pre-antiretroviral therapy era, Gauteng Province, South Africa. Int J STD AIDS. 2011;22:199–203.
Nacher M, Adenis A, Sambourg E, et al. Histoplasmosis or tuberculosis in HIV-infected patients in the amazon: what should be treated first? PLoS Negl Trop Dis. 2014;8:e3290.
Koss CA, Jarlsberg LG, den Boon S, et al. A clinical predictor score for 30-Day mortality among HIV-infected adults hospitalized with pneumonia in Uganda. PLoS One. 2015;10:e0126591.
Le T, Wolbers M, Chi NH, et al. Epidemiology, seasonality, and predictors of outcome of AIDS-associated Penicillium marneffei infection in Ho Chi Minh City. Viet Nam Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2011;52:945–52.
Lim PL, Zhou J, Ditangco RA, et al. Failure to prescribe pneumocystis prophylaxis is associated with increased mortality, even in the cART era: results from the treat Asia HIV observational database. J Int AIDS Soc. 2012;15(1):1.
Hartung TK, Chimbayo D, van Oosterhout JJ, et al. Etiology of suspected pneumonia in adults admitted to a high-dependency unit in Blantyre. Malawi Am J Trop Med Hygiene. 2011;85:105–12.
Ng VL, Yajko DM, Hadley WK. Extrapulmonary pneumocystosis. Clin Microbiol Rev. 1997;10:401–18.
Alvarez-Martinez MJ, Miro JM, Valls ME, et al. Prevalence of dihydropteroate synthase genotypes before and after the introduction of combined antiretroviral therapy and their influence on the outcome of Pneumocystis pneumonia in HIV-1-infected patients. Diagn Microbiol Infect Dis. 2010;68:60–5.
Crothers K, Beard CB, Turner J, et al. Severity and outcome of HIV-associated Pneumocystis pneumonia containing Pneumocystis jirovecii dihydropteroate synthase gene mutations. AIDS. 2005;19:801–5.
Rabodonirina M, Vaillant L, Taffe P, et al. Pneumocystis jirovecii genotype associated with increased death rate of HIV-infected patients with pneumonia. Emerg Infect Dis. 2013;19:21–8. quiz 186
Park BJ, Wannemuehler KA, Marston BJ, Govender N, Pappas PG, Chiller TM. Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS. AIDS. 2009;23:525–30.
van der Horst CM, Saag MS, Cloud GA, et al. Treatment of cryptococcal meningitis associated with the acquired immunodeficiency syndrome. National Institute of Allergy and Infectious Diseases mycoses study group and AIDS Clinical Trials Group. N Engl J Med. 1997;337:15–21.
Day JN, Chau TT, Wolbers M, et al. Combination antifungal therapy for cryptococcal meningitis. N Engl J Med. 2013;368:1291–302.
Pappas PG, Chetchotisakd P, Larsen RA, et al. A phase II randomized trial of amphotericin B alone or combined with fluconazole in the treatment of HIV-associated cryptococcal meningitis. Clin Infect Dis. 2009;48:1775–83.
Larsen RA, Bozzette SA, Jones BE, et al. Fluconazole combined with flucytosine for treatment of cryptococcal meningitis in patients with AIDS. Clin Infect Dis. 1994;19:741–5.
Bicanic T, Meintjes G, Wood R, et al. Fungal burden, early fungicidal activity, and outcome in cryptococcal meningitis in antiretroviral-naive or antiretroviral-experienced patients treated with amphotericin B or fluconazole. Clin Infect Dis. 2007;45:76–80.
Nussbaum JC, Jackson A, Namarika D, et al. Combination flucytosine and high-dose fluconazole compared with fluconazole monotherapy for the treatment of cryptococcal meningitis: a randomized trial in Malawi. Clin Infect Dis. 2010;50:338–44.
Boulware D, Muzoora C, et al. ART initiation within the first 2 weeks of cryptococcal meningitis is associated with higher mortality: a multisite randomized trial. Program and abstracts of the 20th Conference on Retroviruses and Opportunistic Infections Atlanta, Georgia 2013.
Bisson GP, Molefi M, Bellamy S, et al. Early versus delayed antiretroviral therapy and cerebrospinal fluid fungal clearance in adults with HIV and cryptococcal meningitis. Clin Infect Dis. 2013;56:1165–73.
da Cunha Colombo ER, Mora DJ, Silva-Vergara ML. Immune reconstitution inflammatory syndrome (IRIS) associated with Cryptococcus neoformans infection in AIDS patients. Mycoses. 2011;54:e178–82.
Longley N, Harrison TS, Jarvis JN. Cryptococcal immune reconstitution inflammatory syndrome. Curr Opin Infect Dis. 2013;26:26–34.
Supparatpinyo K, Khamwan C, Baosoung V, Nelson KE, Sirisanthana T. Disseminated Penicillium marneffei infection in Southeast Asia. Lancet. 1994;344:110–3.
Chariyalertsak S, Supparatpinyo K, Sirisanthana T. Nelson KE. A controlled trial of itraconazole as primary prophylaxis for systemic fungal infections in patients with advanced human immunodeficiency virus infection in Thailand. Clin Infect Dis. 2002;34:277–84.
Supparatpinyo K, Nelson KE, Merz WG, et al. Response to antifungal therapy by human immunodeficiency virus-infected patients with disseminated Penicillium marneffei infections and in vitro susceptibilities of isolates from clinical specimens. Antimicrob Agents Chemother. 1993;37:2407–11.
Woods JP. Revisiting old friends: developments in understanding Histoplasma capsulatum pathogenesis. J Microbiol. 2016;54:265–76.
Nacher M, Adenis A, Aznar C, et al. How many have died from undiagnosed human immunodeficiency virus-associated histoplasmosis, a treatable disease? Time to act. Am J Trop Med Hyg. 2014;90:193–4.
Theel ES, Harring JA, Dababneh AS, Rollins LO, Bestrom JE, Jespersen DJ. Reevaluation of commercial reagents for detection of Histoplasma capsulatum antigen in urine. J Clin Microbiol. 2015;53:1198–203.
Adenis AA, Aznar C, Couppie P. Histoplasmosis in HIV-infected patients: a review of new developments and remaining gaps. Curr Trop Med Rep. 2014;1:119–28.
Benson CA, Kaplan JE, Masur H, et al. Treating opportunistic infections among HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV medicine association/Infectious Diseases Society of America. MMWR Recomm Rep. 2004;53:1–112.
Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. Accessed 28 June 2018.
Mylonakis E, Barlam TF, Flanigan T, Rich JD. Pulmonary aspergillosis and invasive disease in AIDS: review of 342 cases. Chest. 1998;114:251–62.
Mylonakis E, Paliou M, Sax PE, Skolnik PR, Baron MJ, Rich JD. Central nervous system aspergillosis in patients with human immunodeficiency virus infection. Report of 6 cases and review. Medicine. 2000;79:269–80.
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Patel, A.K. (2020). Mycoses in AIDS. In: Chakrabarti, A. (eds) Clinical Practice of Medical Mycology in Asia. Springer, Singapore. https://doi.org/10.1007/978-981-13-9459-1_6
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DOI: https://doi.org/10.1007/978-981-13-9459-1_6
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