Emerging Infectious Diseases (Nov 2022)

Prevalence of Histoplasmosis among Persons with Advanced HIV Disease, Nigeria

  • Rita O. Oladele,
  • Iriagbonse I. Osaigbovo,
  • Alani S. Akanmu,
  • Olukemi A. Adekanmbi,
  • Bassey E. Ekeng,
  • Yahaya Mohammed,
  • Mary A. Alex-Wele,
  • Mark O. Okolo,
  • Stephen T. Ayanbeku,
  • Uchechukwu S. Unigwe,
  • Iorhen E. Akase,
  • Alali Dan-Jumbo,
  • Dennis Isralski,
  • David W. Denning,
  • Alessandro C. Pasqualotto,
  • Tom Chiller

DOI
https://doi.org/10.3201/eid2811.220542
Journal volume & issue
Vol. 28, no. 11
pp. 2261 – 2269

Abstract

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We sought to determine the prevalence of probable disseminated histoplasmosis among advanced HIV disease (AHD) patients in Nigeria. We conducted a cross-sectional study in 10 sites across 5 of 6 geopolitical zones in Nigeria. We identified patients with urinary samples containing CD4 cell counts 2 clinical features of disseminated histoplasmosis, and we tested them for Histoplasma antigen using a Histoplasma enzyme immune assay. Of 988 participants we recruited, 76 (7.7%) were antigen-positive. The 76 Histoplasma antigen–positive participants had significantly lower (p = 0.03) CD4 counts; 9 (11.8%) were also co-infected with tuberculosis. Most antigen-positive participants (50/76; 65.8%; p = 0.015) had previously received antiretroviral treatment; 26/76 (34.2%) had not. Because histoplasmosis is often a hidden disease among AHD patients in Nigeria, Histoplasma antigen testing should be required in the AHD package of care.

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