U.S. flag

An official website of the United States government

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

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].

Show details

ANNEX 6SYSTEMATIC REVIEW PICO 3: HISTOPLASMOSIS AND TB COINFECTION

Objectives

To evaluate the safety of available treatment strategies for TB and histoplasmosis coinfection among people living with HIV.

The evidence base is limited, and we therefore adapted our objectives to the following:

  • to describe recognized drug–drug interactions between first-line therapies for histoplasmosis, TB, and HIV; and
  • to describe clinical approaches to TB, histoplasmosis, and HIV infection

Methods

Criteria for considering studies for this review

Types of studies

  • Randomized controlled trials
  • Quasi-randomized controlled trials and non-randomized controlled trials
  • Prospective cohort studies, including single-arm cohort studies
  • Retrospective cohort studies, including single-arm cohort studies
  • Case series
  • Case reports

Types of participants

Children, adolescents, and adults living with HIV with coexisting progressive disseminated histoplasmosis and TB.

Types of interventions

  • Itraconazole with rifampicin-based anti-TB regimen
  • Itraconazole with non-rifampicin-based anti-TB regimen

Types of outcome measures

Primary outcomes

  • All-cause mortality
  • Treatment failure of HIV
  • Treatment failure of TB
  • Treatment failure of histoplasmosis

Secondary outcomes

  • Serious adverse events
  • Duration of hospital stay

Methods

We developed our search strategy with the assistance of Vittoria Lutje, Information Specialist. We searched the following: Cochrane Infectious Diseases Group Specialized Register; Central Register of Controlled Trials (CENTRAL), published in The Cochrane Library; MEDLINE (PubMed, from 1966 to present); EMBASE (OVID, from 1947 to present); Science Citation Index Expanded (SCI-EXPANDED, from 1900), Conference Proceedings Citation Index-Science (CPCI-S, from 1900), and BIOSIS Previews (from 1926), all three using the Web of Science platform. We also searched the WHO International Clinical Trials Registry Platform (http://www.who.int/ictrp/search/en), ClinicalTrials.gov, and the ISRCTN registry (www.isrctn.com) to identify ongoing studies.

One reviewer (Marylou Murray) selected studies from the search results and extracted data.

We do not present GRADE evidence profiles, since all the evidence presented is of very low certainty due to the design of the contributing studies.

Results

Results of the search

We found only two studies that could directly inform the PICO. In addition, we report anticipated drug–drug interactions from established databases, but this does not represent a pharmacokinetic review.

Effects of interventions

One retrospective cohort study (41) compared outcomes for different treatment strategies for comorbid disseminated histoplasmosis and people with both TB and HIV. The authors do not comment on antiretroviral drug choices.

One case report (40) indicated outcomes for a single person treated with rifampicin and itraconazole.

One person in ACTG120 receiving rifampicin for Mycobacterium avium-intracellulare – undetectable itraconazole levels, died.

These are summarized in the following table:

StudyStrategyNumber of peopleOutcomes
Agudelo et al. (41)Itraconazole + RHZEAt initiation n = 10After switch n = 7

Loss to follow-up: 1/7

Detectable itraconazole levels: 0/3 measured

Treatment success: 4/6

Death: 1/6

Relapse (TB + progressive disseminated histoplasmosis): 1/6

Itraconazole + quinolone + HZEAt initiation n = 4After switch n = 7

Loss to follow-up: 1/7

Detectable itraconazole levels: 2/2 measured

Treatment success: 4/5 (one switched from RHZE to quinolone HZE because of clinical failure)

Drayton et al. (40)Itraconazole + RHZE1

Undetectable serum itraconazole levels during rifampicin administration.

Discontinuation of R led to improvement in progressive disseminated histoplasmosis.

© Pan American Health Organization and World Health Organization, 2020.

Sales, rights, and licensing. To purchase PAHO publications, visit http://publications.paho.org. To submit requests for commercial use and queries on rights and licensing, visit http://www.paho.org/permissions.

Third-party materials. If material that is attributed to a third party, such as tables, figures, or images, is reused from this work, it is the user’s responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned material or component from this work rests solely with the user.

Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO license (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).

Under the terms of this license, this work may be copied, redistributed, and adapted for non-commercial purposes, provided the new work is issued using the same or equivalent Creative Commons license and it is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that the Pan American Health Organization (PAHO) and the World Health Organization (WHO) endorses any specific organization, product, or service. Use of the PAHO and WHO logo is not permitted.

Bookshelf ID: NBK587197
Contents

Views

  • PubReader
  • Print View
  • Cite this Page
  • PDF version of this title (1.3M)

In this Page

Other titles in this collection

Recent Activity

ClearTurn OffTurn On

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...