Clinical and laboratory predictors of mortality in HIV/AIDS patients with disseminated histoplasmosis: A cohort study in a hyperendemic region of Northeast Brazil

Disseminated histoplasmosis (DH) is a severe opportunistic infection in people living with HIV/AIDS (PLWHA). We aimed to identify predictors of in-hospital death among PLWHA with DH and to assess the prognostic value of novel biomarkers. A cohort study was conducted at the São José Hospital of Infectious Diseases in Fortaleza, Brazil (March 2023-December 2024). Sixty-one patients were included; 15 (24.6%) died during hospitalization. Mortality was strongly associated with peripheral blood detection of Histoplasma capsulatum (relative risk, RR = 5.05; 95% confidence interval, CI = 2.30-11.10). Several laboratory markers were also associated with death, including elevated C-reactive protein (CRP) (P = .001), aspartate aminotransferase (AST) (P = .005), direct bilirubin (P = .017), lactate dehydrogenase levels (P = .011), and hypocalcemia (P = .003). Severe complications-renal replacement therapy (RR = 11.25; 95% CI = 3.64-34.80), mechanical ventilation (RR = 16.82; 95% CI = 4.23-66.84), and shock (RR = 33.44; 95% CI = 4.75-235.72)-were also linked to death. In receiver operating characteristic curve analysis, CRP exhibited the highest predictive performance (area under the curve = 0.787; 95% CI = 0.638-0.935), whereas Angiopoietin-2 showed the highest specificity (0.93). In the multivariate model, AST retained a trend towards an independent association with death (hazard ratio = 1.141; 95% CI 0.983-1.327). DH mortality remains high due to late HIV diagnosis and advanced disease. Early recognition and timely antifungal therapy are essential to improve survival.