Incidence of Histoplasmosis in a Cohort of People with HIV: From Estimations to Reality

Among people with HIV, histoplasmosis represents an important cause of mortality. Previous studies provided estimates of the disease incidence. Here, we compared those estimates with the results obtained from a screening program implemented in Guatemala, which included histoplasmosis detection for people with HIV. To compare the results of this program with previous estimations, a literature search was performed and reports concerning histoplasmosis incidence were analyzed. The screening program enrolled 6366 patients. The overall histoplasmosis incidence in the screening program was 7.4%, which was almost double that estimated in previous studies. From 2017 to 2019, the screening program showed an upward trend in histoplasmosis cases from 6.5% to 8.8%. Histoplasmosis overall mortality among those who were newly HIV diagnosed showed a decrease at 180 days from 32.8% in 2017 to 21.2% in 2019. The screening approach using rapid diagnostic assays detects histoplasmosis cases more quickly, allowing a specific treatment to be administered, which decreases the mortality of the disease. Therefore, the use of these new techniques, especially in endemic areas of histoplasmosis, must be implemented.This work was supported by Global Action Fund for Fungal Infections and JYLAG, a charity Foundation based in Switzerland (E.A. received this funding under the proposal: “Minimising HIV deaths through rapid fungal diagnosis and better care in Guatemala”). Other contributions came from Intrahealth International and the Ministry of health in Guatemala (MSPAS).S

Intervención psicoeducativa-multidisciplinar sobre la adherencia al tratamiento en pacientes con VIH de una asociación civil en Guadalajara, México

Objective. To evaluate the change in adherence to antiretroviral treatment and the regulation of negative emotional states in a sample of patients with HIV who received a psychoeducational-multidisciplinary intervention. Method. Quasi-experimental study. Made up of 17 patients in the experimental group and 14 in the control group from a civil association in Guadalajara, Jalisco, Mex. The Questionnaire for the Evaluation of Adherence to Antiretroviral Treatment (CEAT-HIV) and the Questionnaire for Factors Related to Adherence to Treatment for HIV / AIDS (CFR-AT HIV) were used. Descriptive and non-parametric analyses were carried out to compare the study variables. Results. A significant improvement was found in all the study variables of the experimental group: adherence to treatment, stress, anxiety, and depression. In the control group, significant differences were found only in the variables of stress and anxiety. Discussion. The psychoeducational intervention could be related to a better adherence to antiretroviral treatment and a decrease in the states of stress, anxiety, and depression in the participants of the experimental group, one month after completing the intervention.Objetivo. Evaluar el cambio en la adherencia al tratamiento antirretroviral y la regulación del estado emocional negativo en una muestra de pacientes con VIH, quienes recibieron una intervención psicoeducativa-multidisciplinar. Método. Estudio cuasiexperimental, conformado por 17 pacientes en el grupo experimental y 14 en el control, de una asociación civil en Guadalajara, Jalisco, México. Se utilizó el Cuestionario para la Evaluación de la Adhesión al Tratamiento Antirretroviral (CEAT-VIH) y el Cuestionario de Factores Relacionados con la Adherencia al Tratamiento para el VIH/SIDA (CFR-AT VIH). Se realizaron análisis descriptivos y no paramétricos para la comparación de las variables de estudio. Resultados. Se encontró una mejora significativa en todas las variables de estudio del grupo experimental: adherencia al tratamiento, estrés, ansiedad y depresión. En el grupo control solo se encontraron diferencias significativas en las variables de estrés y ansiedad. Conclusión. La intervención psicoeducativa podría relacionarse con una mejor adherencia al tratamiento antirretroviral y una disminución en los estados de estrés, ansiedad y depresión en los participantes del grupo experimental, al mes de haber culminado la intervención

Impact of the COVID-19 pandemic on HIV care in Guatemala

Objectives: To describe the impact of the coronavirus disease 2019 (COVID-19) pandemic on the diagnosis of human immunodeficiency virus (HIV) and deaths from opportunistic infections in Guatemala. Methods: A retrospective study was conducted to investigate the impact of the COVID-19 pandemic on people with HIV at a referral clinic (Clinica Familiar Luis Angel García, CFLAG), as well as the disruption of services at a diagnostic laboratory hub (DLH) which provides diagnosis for opportunistic infections to a network of 13 HIV healthcare facilities. Comparative analysis was undertaken using the months March-August from two different time periods: (i) pre-COVID-19 (2017-2019); and (ii) during the COVID-19 period (2020). Results: During the COVID-19 period, 7360 HIV tests were performed at Clinica Familiar Luis Angel García, compared with an average of 16,218 tests in the pre-COVID-19 period; a reduction of 54.7% [95% confidence interval (CI) 53.8-55.4%],Deaths from opportunistic infections at 90 days were 10.7% higher in 2020 compared with 2019 (27.3% vs 16.6%; P = 0.05). Clinical samples sent to the DLH for diagnosis of opportunistic infections decreased by 43.7% in 2020 (95% CI 41.0-46.2%). Conclusion: The COVID-19 pandemic is having a substantial impact on HIV care in Guatemala. Diagnostic services for HIV have been severely affected and deaths from opportunistic infections have increased. The lessons learnt must guide the introduction of strategies to reduce the impact of the pandemic.S

A Rapid Screening Program for Histoplasmosis, Tuberculosis, and Cryptococcosis Reduces Mortality in HIV Patients from Guatemala.

Opportunistic infections (OIs) and advanced HIV disease (AHD) contribute to HIV-related mortality. Here, we analyzed the situation of AHD and OIs in a cohort of newly diagnosed HIV patients from Guatemala. We included 2127 adult patients from 13 facilities across the country during 2017 to 2018. Patients were screened for tuberculosis (TB), nontuberculous mycobacteria (NTM), histoplasmosis, and cryptococcal disease, independently of their CD4 cell count. Of the 2127 enrolled patients, 1682 (79.1%) had a CD4 cell count available; of which 52% presented with AHD. Of the Mayan population, 65% had AHD. The overall OI incidence was 21%. Histoplasmosis was the most frequent OI (7.9%), followed by TB (7.1%); 94.4% of these infections occurred in patients with a CD4 < 350 cells/mm3. Mortality at 180 days was significantly higher in those with OIs than without OIs (29.7% vs. 5.9%, p < 0.0001). In one year, this program decreased the OI mortality by 7% and increased the OI treatment by 5.1%. Early OI diagnosis and appropriate therapy reduced OI mortality among newly diagnosed HIV patients in Guatemala. Screening for OIs should be considered in all newly diagnosed HIV patients who have a CD4 cell count < 350 cells/mm3 or those without a CD4 cell count available. To improve results, interventions such as early HIV detection and access to flucytosine and liposomal amphotericin B are required.This work was supported by Global Action Fund for Fungal Infections and JYLAG, a charity Foundation based in Switzerland (E.A. received this funding under the proposal: “Minimising HIV deaths through rapid fungal diagnosis and better care in Guatemala”). Other contributions came from AIDS Health Foundation (AHF) Guatemala, Intrahealth International and Ministry of health in Guatemala (MSPAS).S