Prevalence of Histoplasmosis among Persons with Advanced HIV Disease, Nigeria

We sought to determine the prevalence of probable dis-seminated histoplasmosis among advanced HIV disease (AHD) patients in Nigeria. We conducted a cross-sec-tional study in 10 sites across 5 of 6 geopolitical zones in Nigeria. We identified patients with urinary samples con-taining CD4 cell counts <200 cells/mm3 or World Health Organization stage 3 or 4 disease who also had >2 clinical features of disseminated histoplasmosis, and we tested them for Histoplasma antigen using a Histoplasma enzyme immune assay. Of 988 participants we recruited, 76 (7.7%) were antigen-positive. The 76 Histoplasma antigen-positive participants had significantly lower (p = 0.03) CD4 counts; 9 (11.8%) were also co-infected with tuberculosis. Most antigen-positive participants (50/76; 65.8%; p = 0.015) had previously received antiretroviral treatment; 26/76 (34.2%) had not. Because histoplasmo-sis is often a hidden disease among AHD patients in Ni-geria, Histoplasma antigen testing should be required in the AHD package of care.