Guideline

Guidelines for Diagnosing and Managing Disseminated Histoplasmosis among People Living with HIV

Year of Publication

2020

Issuing Institution

Pan American Health Organization

Links

Virtual Health Library

Recommendations

9 included recommendations

Among people living with HIV, disseminated histoplasmosis should be diagnosed by detecting circulating Histoplasma antigens

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

Treating people living with HIV for severe or moderately severe histoplasmosis: liposomal amphotericin B, 3.0 mg/kg, for two weeks is recommended. In settings in which liposomal amphotericin B is unavailable, deoxycholate amphotericin B, 0.7–1.0 mg/kg, is recommended for two weeks

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

Treating severe or moderately severe histoplasmosis among people living with HIV: In settings where liposomal amphotericin B is unavailable, deoxycholate amphotericin B, 0.7–1.0 mg/kg, is recommended for two weeks

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

Treating mild to moderate histoplasmosis among people living with HIV: itraconazole 200 mg three times daily for three days and then 200 mg twice daily is recommended

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

(Treating mild to moderate histoplasmosis among people living with HIV, itraconazole:) Maintenance therapy: itraconazole 200 mg twice daily for 12 months is recommended

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

(Treating mild to moderate histoplasmosis among people living with HIV, itraconazole:) Maintenance therapy: Less than 12 months of therapy can be considered when the person is clinically stable, receiving antiretroviral therapy, has suppressed viral load, and the immune status has improved

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

Timing of antiretroviral therapy initiation: antiretroviral therapy should be initiated as soon as possible among people with disseminated histoplasmosis for whom central nervous system involvement is not suspected or proven

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

People living with HIV with TB and histoplasmosis coinfection should receive TB therapy according to WHO treatment guidelines

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

As a good practice for people with renal failure, or at risk of renal injury, measures to prevent or treat toxicity are recommended

Status

Maintained