IDSA Recommendations for Preventing and Treating Histoplasma Capsulatum Infections in HIV-AIDS Indications for Initiating Primary Prophylaxis: • CD4 count <150 cells/mm3 and at high risk because of occupational exposure or living in a community with a hyperendemic rate of histoplasmosis (>10 cases/100 patient-years) (BI) Preferred Therapy: • Itraconazole 200 mg PO once daily (BI) Discontinue Primary Prophylaxis: • If used, may discontinue if CD4 count ≥150 cells/mm3 for 6 months on ART (BIII) Indication for Restarting Primary Prophylaxis: • CD4 count <150 cells/mm3 Treating Moderately Severe to Severe Disseminated Disease Induction Therapy - Preferred Therapy: • Liposomal amphotericin B at 3 mg/kg IV daily (AI) Duration: • For at least 2 weeks or until clinically improved Maintenance Therapy - Preferred Therapy: • Itraconazole 200 mg PO TID for 3 days, then BID for at least 12 months (AII), with dosage adjustment based on interactions with ARV (see Table 5) and itraconazole serum concentration #Histoplasma #Capsulatum #Histoplasmosis #IDSA #Prevention #Treatment #management #opportunistic #infections #HIVAIDS #pharmacology
