IDSA Recommendations for Preventing and Treating Histoplasma ...
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IDSA Recommendations for Preventing and Treating Histoplasma Capsulatum Infections in HIV-AIDS

Indications for Initiating Primary Prophylaxis:

 • CD4 count <150 cells/mm3 and at high risk because of occupational exposure or living in a community with a hyperendemic rate of histoplasmosis (>10 cases/100 patient-years) (BI)

Preferred Therapy:

 • Itraconazole 200 mg PO once daily (BI)

Discontinue Primary Prophylaxis:

 • If used, may discontinue if CD4 count ≥150 cells/mm3 for 6 months on ART (BIII)

Indication for Restarting Primary Prophylaxis:

 • CD4 count <150 cells/mm3

Treating Moderately Severe to Severe Disseminated Disease

Induction Therapy - Preferred Therapy:

 • Liposomal amphotericin B at 3 mg/kg IV daily (AI)

Duration:

 • For at least 2 weeks or until clinically improved

Maintenance Therapy - Preferred Therapy:

 • Itraconazole 200 mg PO TID for 3 days, then BID for at least 12 months (AII), with dosage adjustment based on interactions with ARV (see Table 5) and itraconazole serum concentration 



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Contributed by

Dr. Gerald Diaz
@GeraldMD
Board Certified Internal Medicine Hospitalist, GrepMed Editor in Chief 🇵🇭 🇺🇸 - Sign up for an account to like, bookmark and upload images to contribute to our community platform. Follow us on IG:  https://www.instagram.com/grepmed/ | Twitter: https://twitter.com/grepmeded/
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