Adenis AA, et al. - Researchers assessed the burden of HIV-associated histoplasmosis vs tuberculosis in Latin American countries. Findings suggested high estimates of histoplasmosis incidence and deaths. These estimates are consistent with published data. Compared with tuberculosis among people living with HIV, the burden of histoplasmosis is estimated to be equivalent in incidence and even higher in deaths in Latin America, and this is the first time for these findings.

Methods

• Authors in this modelling study estimated prevalence of previous exposure to Histoplasma capsulatum, HIV-associated histoplasmosis annual incidence, and number of deaths in 2012 in Latin American countries based on historical histoplasmin skin test studies in the general population, with an antigen dilution level of more than 1/10.
• They identified the studies in a literature search.
• They extracted the data on HIV-associated tuberculosis from the WHO notifications and outcomes tables and data on people living with HIV were extracted from the UNAIDS report for the year 2012.
• Uncertainty was systematically propagated throughout all the steps of the estimation process.

Results

• As per data, among 1,310 articles identified as of June 1, 2015, 24 articles were included in the study, representing 129 histoplasmin skin test studies led in the general population of Latin American countries.
• They estimated a range of 6,710 (95% CI 5680-7867) to 15,657 (13,254-18,357) cases of symptomatic HIV-associated histoplasmosis in Latin America for the year 2012.
• Central America, the northernmost part of South America, and Argentina were the hotspot areas for histoplasmosis prevalence (>30%) and incidence (>1.5 cases per 100 people living with HIV).
• According to realistic scenarios, compared with 5,062 (3,777-6,405) deaths related to tuberculosis reported in Latin America, they estimated a range of 671 (95% CI 568-787) to 9,394 (7,952-11,014) deaths related to histoplasmosis.