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. 2025 Jul;31(7):1377-1385.
doi: 10.3201/eid3107.241931.

Disseminated Histoplasmosis in Persons Living with HIV, France and Overseas Territories,1992-2021

Mathieu Nacher, Esaïe Marshall, Firouze Bani-Sadr, Sandrine Peugny, Blandine Denis, Elise Ouedraogo, Sebastien Gallien, Agnes Meybeck, Ugo Françoise, Antoine Adenis, Nicolas Vignier, Pierre Couppié, Pierre Sellier, Sophie Grabar

Disseminated Histoplasmosis in Persons Living with HIV, France and Overseas Territories,1992-2021

Mathieu Nacher et al. Emerg Infect Dis. 2025 Jul.

Abstract

Disseminated histoplasmosis is a major issue among persons with advanced HIV in the Americas; it might also affect persons in sub-Saharan Africa, the Caribbean, and Asia and can be mistaken for other infections. By using 1992-2021 data from the French hospital database on HIV, we analyzed 198,798 persons with HIV follow-up in France and its overseas territories, identifying 553 (2.8/1,000 person-years) first episodes of disseminated histoplasmosis. Incidence rates varied by site of follow-up: 9.41 in French Guiana, 0.76 in Guadeloupe, 0.62 in Martinique, and 0.079 in mainland France. Incidence rates in France also varied between regions of origin or travel: 4.73 for Central or South America, 1.36 for the Caribbean, and 0.19 for sub-Saharan Africa or Asia. Differences persisted after adjusting for age, sex, CD4 count, and viral load at baseline. Overall, incidence and early death have declined, likely because of antiretroviral drug rollout in France.

Keywords: Africa; Americas; Asia; Caribbean; France; HIV/AIDS and other retroviruses; Histoplasma spp.; fungal infection; fungi; global burden; histoplasmosis; incidence.

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Figures

Figure 1
Figure 1
Incidence rate of disseminated histoplasmosis in persons living with HIV from France and overseas territories of France by different subgroups,1992–2021. Other sex refers to persons whose personal identity is discordant from their birth sex.
Figure 2
Figure 2
Evolution of the annual incidence rate of disseminated histoplasmosis per 1,000 person-years in mainland France, the French Antilles, and French Guiana, 1992–2021. Scales for the y-axes differ substantially to underscore patterns but do not permit direct comparisons.
Figure 3
Figure 3
Kaplan-Meier survival curve representing deaths among disseminated histoplasmosis in persons living with HIV, by calendar time periods, France and overseas territories, 1992–2021.
See this image and copyright information in PMC

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