A new study in Ghana has revealed that there are twice as many life-threatening patients with disseminated histoplasmosis (4.7%) as cryptococcal meningitis (2%) in people with HIV infection.
Bright Ocansey and colleagues at Korle-Bu Teaching Hospital in Accra and Juaboso Government Hospital in Western North Ghana recruited 150 patients and tested for Histoplasma antigen in urine and cryptococcal antigen in sera. Positive patients had confirmatory testing, including lumbar puncture and skin biopsy.
Published in the prestigious journal Open Forum Infection Diseases, the authors comment: ‘Histoplasmosis among HIV patients may be more common than previously anticipated and may be more frequent than cryptococcosis in Ghana.’ Their findings mirror prior work from Cameroon and yet to be published work from Nigeria.
Dr Isabella Asamoah, Infectious Diseases specialist and team lead at Korle-Bu Teaching Hospital commenting on this first-ever prospective study of histoplasmosis in Ghana in HIV patients said:
“testing makes it easy to prove to colleagues that invasive fungal infections do occur and also can rule them out.”
Disseminated histoplasmosis in AIDS is fatal unless treated promptly. It has been recognised in the Americas for decades, but less so in other parts of the world. According to UNAIDS, Western and Centra Africa has not received the same domestic and international attention as Eastern and Southern Africa. About 150,000 people die of AIDS in Western and Central Africa each year, about 25% of the global total. Women and girls accounted for 58% of the estimated 240,000 new HIV infections in 2019, only 58% of people living with HIV were accessing antiretroviral therapy in 2019 and only 45% had viral load suppression. Late presentation of advanced HIV infection is common and antiretroviral therapy failure and early discontinuation is also common (78.3% in the study in Ghana).
GAFFI has shown in a national study in Guatemala that actively screening for histoplasmosis in HIV patients saves lives – over 10%. The antigen test on urine is over 90% accurate. The study in Guatemala also showed that fewer erroneous diagnoses of tuberculosis were made, and the survival of these patients rose by 15%, because the correct therapy was given. It is likely that many people in Africa with histoplasmosis are incorrectly treated with anti-tuberculous therapy and die as a result.
Commenting on these results and as a study co-author, Professor David Denning of The University of Manchester and Chief Executive of Global Action For Fungal Infections (GAFFI) said: “We continue to be surprised by how little we really know of the epidemiology of fungal infections in parts of the world with poor diagnostic capability. Ghana has been almost devoid of fungal diagnostic capability, and so these findings are revelatory and of profound importance in controlling the HIV/AIDS epidemic.”
Link to paper:
link to https://gaffi.org/where/demonstration-site/
link to https://gaffi.org/who/our-ambassadors/ghana/