Updates to the Histoplasmosis Section of the Adult and Adolescent Opportunistic Infections Guidelines

September 20, 2019

The Histoplasmosis section of the Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV has been updated. The Panel made the following key changes:

  • For both primary and secondary prophylaxis, an undetectable HIV viral load as well as a CD4 count >150 cells/mm3 should be present for 6 months before therapy is stopped in patients taking antiretroviral therapy (ART).
  • For the treatment of patients who do not tolerate itraconazole, voriconazole and posaconazole are discussed in greater detail than before; suggested doses are given, as well as therapeutic serum concentrations that should be sought.
  • Data on the measurement of Histoplasma antigen in serum, urine, bronchoalveolar lavage (BAL) fluid, and cerebrospinal fluid (CSF) is discussed more extensively than previously and has been updated with current terminology using ng/mL instead of units.

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