Treating progressive disseminated histoplasmosis in people living with HIV

What was the aim of this review?

The aim of this Cochrane Review was to investigate some treatment dilemmas with progressive disseminated histoplasmosis in people living with HIV. We collected and analysed all relevant studies to answer this question and found 17 studies.

Key messages

Liposomal amphotericin B may improve clinical success compared to deoxycholate amphotericin B when starting treatment.

Liposomal amphotericin B results in less kidney damage compared to deoxycholate amphotericin B when starting treatment.

We are unsure how long people should stay on treatment after they have successfully completed the starting stage. We are unsure at what time during treatment of the fungal infection it is best to start treatment to fight the HIV virus.

What was studied in this review?

Histoplasmosis is an infection caused by inhaling a fungus called Histoplasma. The most severe form of histoplasmosis is called progressive disseminated histoplasmosis, in which the infection spreads from the lungs to other organs. It is life‐threatening for people with advanced HIV.

The treatment of progressive disseminated histoplasmosis starts with 'induction', in which medicines are started to rapidly attack the fungus. The next phase is called 'maintenance', in which medicines are used to prevent the fungus taking hold again. During treatment of the fungus, antiretroviral medicines are started to fight the HIV virus.

We wanted to find out the best induction treatment, if maintenance could be for less than one year, and when was the best time to start antiretroviral medicines.

What are the main results of the review?

We found 17 studies. We removed eight from the review as they did not include important measurements that might change results. These included how severe the HIV infection was, or if the patients had other infections at the same time.

One study compared two forms of the same medicine for starting treatment of histoplasmosis, liposomal amphotericin B and deoxycholate amphotericin B. It found that the more expensive liposomal form is less likely to cause kidney damage and may have higher clinical success rates than the deoxycholate form.

None of the studies looked at whether maintenance could be less than one year. Two studies looked a antiretroviral medicines, but we do not know when it is best to start them.

How up to date is the review?

We searched for studies that had been published up to 20 March 2020.