Mortality associated with Cryptococcus neoformans and Histoplasma capsulatum in HIV-infected patients at a hospital in Guatemala

Abstract

Human immunodeficiency virus (HIV) remains a global challenge, particularly due to opportunistic infections associated with advanced immunosuppression. Cryptococcus neoformans and Histoplasma capsulatum are clinically important pathogens that contribute to high mortality among patients with HIV. To describe the mortality attributable to these infections, a descriptive and retrospective investigation was conducted to analyze mortality from these fungal infections among adult patients with HIV treated at the Comprehensive Care Unit of Roosevelt Hospital in Guatemala between 2003 and 2023. The population included 3,036 patients, and data from the MANGUA system were used to describe mortality attributable to these infections. The results recorded 78 deaths attributed to C. neoformans and 84 to H. capsulatum, accounting for less than 3% of the deaths reported in the study cohort. More than 70.0% occurred among men. The median age was 39 years and 36 years for C. neoformans and H. capsulatum, respectively. Approximately 40–50% did not receive antiretroviral therapy (ART) and had low CD4+ lymphocyte counts (medians < 50 cells/µL). Multiple coinfections were also observed. It is concluded that the findings highlight the need to strengthen the early detection of HIV infection and associated opportunistic infections, timely access to treatment, and comprehensive patient follow-up, as well as to ensure the continuous availability of antifungal medications and secondary prophylaxis in accordance with current guidelines, while also maintaining epidemiological surveillance.