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Guidelines for Diagnosing and Managing Disseminated Histoplasmosis among People Living with HIV [Internet]. Washington (DC): Pan American Health Organization; 2020 Apr.

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

Guidelines for Diagnosing and Managing Disseminated Histoplasmosis among People Living with HIV [Internet].

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ANNEX 2SUMMARY OF JUDGMENTS ON POPULATION, INTERVENTION, COMPARISON, AND OUTCOME (PICO) QUESTIONS

PICO 1PICO 2APICO 2BPICO 2CPICO 3
ProblemFavors this optionYesProbably noYesYes
Desirable effectsFavors this optionModerateModerateDon’t knowModerate
Undesirable effectsFavors this optionTrivialTrivialSmallLarge
ValuesFavors this optionNo important uncertainty or variabilityNo important uncertainty or variabilityPossibly important uncertainty or variabilityPossibly important uncertainty or variability
Balance of effectsFavors this optionProbably favors the interventionProbably favors the interventionDon’t knowProbably favors the intervention
AcceptabilityFavors this optionYesYesProbably yesYes
FeasibilityFavors this optionYesYesYesYes
Certainty of the evidence–LowNo included studiesNo included studiesVery low
Certainty of the evidence of test accuracyProbably favors this option––––
Certainty of the evidence of test’s effectsProbably favors this option––––
Certainty of the evidence of management’s effectsProbably favors this option––––
Certainty of the evidence of the test result and managementProbably favors this option––––
Cost-effectivenessProbably favors this option––––
Certainty of effectsNeither favors this or other options––––
Test accuracyFavors this option––––

–: does not apply; PICO: population, intervention, comparison, and outcome. PICO 1. Among people with HIV disease, is antigen testing versus standard microbiological techniques of diagnosis associated with an increase in the diagnosis of histoplasmosis and a decrease in mortality? PICO 2A. Does liposomal amphotericin B as initial therapy for severe or moderately severe progressive disseminated histoplasmosis have better efficacy and safety than alternative antifungal treatments? PICO 2B. Is there a difference in histoplasmosis relapse rate between less than 12 months or more than 12 months of oral antifungal maintenance therapy for progressive disseminated histoplasmosis among people living with HIV? PICO 2C. Is early antiretroviral therapy (less than two weeks) preferable to deferred antiretroviral therapy (two weeks or more) among people living with HIV who have progressive disseminated histoplasmosis? PICO 3. How does HIV or TB therapy need to be modified to obtain successful outcomes for people coinfected with TB, HIV, and H. capsulatum?

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