TreatmentUpdate61; Volume 7, No. 7 - July 1995
Sean Hosein

Another fungus (H. capsulatum) can cause life- threatening complications called histo histoplasmosis) in people with AIDS. Usually this fungus causes disease "in the South central USA and South America." Although the yeast tends to attack the lungs first, it can spread to other parts of the body. Symptoms may include:

+ fever + skin lesions + lower than normal levels of red blood cells + weight loss + swollen liver/spleen/lymph node

People with HIV/AIDS who also develop histo tend to have less than 100 CD4+ cells. Technicians can test blood and urine samples for parts of the fungus or identify it with dyes and a microscope. Treatment is usually amphotericin B or itraconazole

* STUDY DETAILS

Researchers reported data on 59 subjects (55 males, 4 females), all of whom were having their first bout of histo. Subjects received itraconazole 300 mg twice daily (total daily dose of 600 mg) for the first 3 days and then 200 mg twice daily with meals for 3 months. No subject had severe histo. Subjects were monitored for up to 14 weeks.

* RESULTS BENEFITS

According to the researchers, 50 subjects improved when they received itraconazole. These subjects had increased energy/less fatigue, loss of fever and weight gain. For many subjects these improvements happened within the first month of the study. Levels of fungus in the blood and urine fell dramatically within 2 weeks of using itraconazole. By the 8th week of the study, most signs/symptoms had cleared in 90% of the responding subjects.

* DISEASE DESPITE ITRACONAZOLE

Six subjects became worse despite receiving itraconazole, and 2 of those died. The remaining 4 "recovered after being switched to [AmB]." The doctors did not know why these subjects did not recover when they received itraconazole.

* TOXICITY

Two subjects left the study because of side effects from the itraconazole including; fever, swollen liver, rash, nausea and vomiting. Once these subjects were given amphotericin B instead of itraconazole their side effects cleared.

Although the results from this study suggest that itraconazole is promising treatment histo, it may not be the best drug for serious cases of histo. It may be interesting to see results of long term monitoring of subjects treated with itraconazole and those treated with amphotericin B.

REFERENCES:

1. Wheat J. Hafner R. Korzun AH, et al. Itraconazole treatment of disseminated histoplasmosis in patients with the Acquired Immunodeficiency Syndrome. American Journal of Medicine 1995;98:336-342.

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