Coccidioidomycosis in Human Immunodeficiency Virus-Infected Persons in Arizona, 1994 - 1997: Incidence, Risk Factors, and Prevention [Woods CW, et al. JID 2000;181:1428]: The authors reviewed 153 cases of coccidioidomycosis in HIV-infected patients in Arizona during the period January 1995 through June 1997. Among patients living with AIDS, the incidence of symptomatic coccidioidomycosis was about 4%/year compared to 0.2% for those with HIV infection without AIDS and 0.015% for the general population. Multivariate analysis showed that African-American race and history of thrush or esophageal candidiasis was associated with an increased risk for this complication. Therapy with a protease inhibitor or an azole conferred protection.
Comment: There are relatively few studies of coccidioidomycosis in patients with HIV infection. This study shows a relative risk of about 300-fold and also shows a possible advantage with azole prophylaxis. The authors recommend a consideration of azole prophylaxis for HIV-infected persons living in the endemic area who have CD4 cell counts <200/mm³, are African-American, or who have a history of thrush. posted 7/3/2000