What is the treatment for coccidioidomycosis in HIV-infected patients?

Updated: Aug 27, 2019
  • Author: Duane R Hospenthal, MD, PhD, FACP, FIDSA, FASTMH; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

In the appropriate geographical setting, coccidioidomycosis is the most common opportunistic infection in patients with HIV. Presentation with coccidioidomycosis may lead to the diagnosis of HIV, or the disease can manifest if CD4+ counts fall to low levels. [92] Co-infection with coccidioidomycosis and tuberculosis have been described.

The introduction of antiretroviral (ARV) therapy has led to a decline in the rates of coccidioidomycosis morbidity. Patients on ARV therapy who have higher CD4+ counts and undetectable HIV RNA levels tend to have less severe disease.

Primary prophylaxis for patients with HIV in endemic areas is not recommended routinely. Treatment of active disease is the same as in other patients; however, if the CD4+ cell count is less than 250/μL, antifungal therapy should continue until the count recovers to above 250 cells/μL. Indefinitely continue suppressive therapy after active disease (ie, secondary prophylaxis) with oral itraconazole (200 mg twice a day) or fluconazole (400 mg each day), regardless of the CD4+ cell count.


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