Tuberculosis and histoplasmosis among human immunodeficiency virus-infected patients: a comparative study

• Published in: The American journal of tropical medicine and hygiene Vol. 90; no. 2; pp. 216 - 223
• Main Authors: Adenis, Antoine, Nacher, Mathieu, Hanf, Matthieu, Basurko, Célia, Dufour, Julie, Huber, Florence, Aznar, Christine, Carme, Bernard, Couppie, Pierre
• Format: Journal Article
• Language: English
• Published: United States American Society of Tropical Medicine and Hygiene 01-02-2014; The American Society of Tropical Medicine and Hygiene
• Subjects: Adult; AIDS-Related Opportunistic Infections; AIDS-Related Opportunistic Infections - complications; AIDS-Related Opportunistic Infections - diagnosis; AIDS-Related Opportunistic Infections - drug therapy; AIDS-Related Opportunistic Infections - epidemiology; C-Reactive Protein; Female; Histoplasmosis; Histoplasmosis - complications; Histoplasmosis - diagnosis; Histoplasmosis - drug therapy; Histoplasmosis - epidemiology; HIV Infections; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - epidemiology; Human immunodeficiency virus; Humans; Life Sciences; Logistic Models; Male; Middle Aged; Multivariate Analysis; Mycobacterium; Odds Ratio; Retrospective Studies; Santé publique et épidémiologie; Tuberculosis; Tuberculosis - complications; Tuberculosis - diagnosis; Tuberculosis - drug therapy; Tuberculosis - epidemiology; AIDS; Histoplasmosis; Tuberculosis; HIV; French Guiana
• ISSN: 0002-9637; 1476-1645
• DOI: 10.4269/ajtmh.13-0084

In disease-endemic areas, histoplasmosis is the main differential diagnosis for tuberculosis among human immunodeficiency virus (HIV)-infected patients. However, no study has compared the two diseases. Thus, the objective of this study was to compare tuberculosis and histoplasmosis in HIV-infected patients. A population of 205 HIV-infected patients (99 with tuberculosis and 106 with histoplasmosis) hospitalized in Cayenne, French Guiana during January 1, 1997-December 31, 2008 were selected retrospectively from the French Hospital Database on HIV. Multivariate analysis showed that tuberculosis was associated with cough (adjusted odds ratio [AOR] = 0.20, 95% confidence interval [CI] = 0.05-0.73) and a C-reactive protein level > 70 mg/L (AOR = 0.98, 95% CI = 0.97-0.99). Variables associated with disseminated histoplasmosis were a γ-glutamyl transferase level > 72 IU/L (AOR = 4.99, 95% CI = 1.31-18.99), origin from French Guiana (AOR = 5.20, 95% CI = 1.30-20.73), disseminated localization (AOR = 6.40, 95% CI = 1.44-28.45), a concomitant opportunistic infection (AOR = 6.71, 95% CI = 1.50-29.96), a neutrophil count < 2,750 cells/mm(3) (AOR = 10.54, 95% CI = 2.83-39.24), a CD4 cell count < 60 cells/mm(3) (AOR = 11.62, 95% CI = 2.30-58.63), and a platelet count < 150,000/mm(3) (AOR = 19.20, 95% CI = 3.35-110.14). Tuberculosis and histoplasmosis have similarities, but some factors show a greater association with one of these diseases. Thus, adapted therapeutic choices can be made by using simple clinical and paraclinical criteria.