Histoplasmosis rates likely underreported among HIV patients in Nigeria

Histoplasmosis is not uncommon among patients with advanced HIV disease in Nigeria, and is likely underreported among those with HIV/AIDS.

Due to its status as a hidden disease among these patients, Histoplasma antigen testing should be required in the package of care for those with advanced disease, experts said (Emerg Infect Dis 2022;28[11]:2261-2269).

Nigeria recently adopted a package of care for those with advanced HIV that includes histoplasmosis screening. However, it has yet to be implemented. Globally, Nigeria has the seventh highest rate of tuberculosis. Because histoplasmosis is commonly misdiagnosed as TB, it is likely that histoplasmosis is frequently misdiagnosed, they said.

From November 2019 through June 2021, a cross-sectional survey was conducted in 10 sites across five geopolitical zones in Nigeria. A total of 988 patients with advanced HIV were included in the study, 38.2% of whom were male and 61.8% of whom were female. All participants had clinical symptoms suggestive of TB or histoplasmosis.

The study found 7.7% of patients with advanced disease had histoplasmosis, 11.8% of whom had TB coinfection.

“This is not a survivable infection with specific antifungal therapy,” Rita O. Oladele, MD, PhD, a senior lecturer at the Lagos University Teaching Hospital, in Nigeria, told Infectious Disease Special Edition.

Although much remains to be understood about histoplasmosis in Nigeria, the researchers noted that the results confirm that histoplasmosis is likely underreported among people with HIV/AIDS, and is partly obscured by diagnoses of TB.

“Nigeria, and many parts of Africa, need to ramp up testing for histoplasmosis in advanced HIV disease urgently,” Dr. Oladele said. “This unseen cause of death is a major contribution to ‘tuberculosis’ deaths in AIDS that are not TB at all.”

By Ethan Covey