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American Journal Respiratory Critical Care Medicine

Citing the profound immunodeficiency in many individuals infected with human immunodeficiency virus (HIV), the American Thoracic Society (ATS) has published a statement on fungal infections associated with HIV infection. The statement notes that because of the spectrum of immune defects in persons with HIV infection and acquired immunodeficiency syndrome, and because of the abundance of fungi in the environment, the proportion of individuals whose health has been complicated by fungal disease has probably been underestimated by the Centers for Disease Control and Prevention. According to CDC data, fungal disease accounted for 20 percent of AIDS-defining diseases between 1987 and 1988.

The ATS statement discusses epidemiology, clinical manifestations, diagnosis and treatment of Candida infections, cryptococcosis, histoplasmosis, coccidioidomycosis, blastomycosis and aspergillosis. Pneumocystis carinii, previously thought of as a parasite, is not considered to be a fungus by many authorities, according to the report.

Oral candidiasis occurs in virtually all patients at some time during HIV infection. The presence of oral candidiasis is a predictor for progression to AIDS, according to the ATS. But the low frequency of disseminated Candida disease in AIDS patients is in marked contrast to the high frequency of other fungal diseases, such as cryptococcosis, histoplasmosis and coccidioidomycosis. Cryptococcosis is cited as the most common systemic fungal infection in HIV-infected persons, with cryptococcal meningitis in AIDS patients causing significant morbidity and mortality.

The ATS statement appears in the August 1995 issue of the American Journal of Respiratory and Critical Care Medicine. More information can be obtained from the ATS (telephone: 212-315-8709; fax: 212-315-6498).

COPYRIGHT 1995 American Academy of Family Physicians
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