Abstract：
Paracoccidioidomycosis (PCM) is one of the main endemic systemic mycoses in Latin America, usually occurring in rural areas. When PCM occurs simultaneously with underlying immunosuppressive conditions, it can present as an opportunistic disease. Between 2000 and 2017, literature reported around 200 PCM cases in people living with HIV/AIDS (PLWHA). To address research gaps on this co-infection and to study its possible temporal changes in the last decade, we performed an active co-infection case search on the HIV/AIDS and PCM cohorts from a Brazilian reference center database from 1989 to 2019. We found 20 PLWHA among 684 PCM patients (2.92%), predominantly male (70.0%) and urban workers (80.0%). The median age of patients was higher in the 2010-2019 decade (p = 0.006). The occurrence of PCM in PLWHA was lower when compared with other fungal diseases. Although 50.0% of the patients had already been diagnosed with HIV infection and presented CD4+ T cell counts greater than 200/mm3 at the time of PCM diagnosis, the suspicion of immunosuppression in the context of atypical and more severe clinical forms of PCM revealed the diagnosis of HIV infection in 35.0% of the patients. Two (10.0%) patients had an evolution compatible with immune reconstitution inflammatory syndrome (IRIS) after starting antiretroviral therapy (ART).We highlight the importance of considering a PCM diagnosis in PLWHA to prevent a late-onset treatment and progression to severe manifestations and unfavorable outcomes. In addition, HIV investigation is recommended in PCM patients, especially those with atypical and more severe clinical presentations.
摘要：
副角菌病（PCM）是拉丁美洲主要的地方性全身性真菌病之一，通常发生在农村地区。当PCM与潜在的免疫抑制疾病同时发生时，它可以表现为机会性疾病。在2000年至2017年之间，文献报道了约200例HIV/AIDS患者（PLWHA）的PCM病例。为了解决这种共同感染的研究空白，并研究其在过去十年中可能的时间变化，从1989年至2019年,我们对巴西参考中心数据库中的HIV/AIDS和PCM队列进行了积极的合并感染病例搜索.我们发现684例PCM患者中有20例PLWHA(2.92%)，主要是男性（70.0％）和城市工人（80.0％）。在2010-2019年十年中，患者的中位年龄更高（p=0.006）。与其他真菌疾病相比，PLWHA中PCM的发生率较低。尽管50.0％的患者已经被诊断出患有HIV感染，并且在PCM诊断时CD4T细胞计数超过200/mm3，在非典型和更严重的PCM临床形式的情况下,怀疑免疫抑制提示35.0%的患者诊断为HIV感染.开始抗逆转录病毒治疗（ART）后，两名（10.0％）患者的进化与免疫重建炎症综合征（IRIS）相符。我们强调了在PLWHA中考虑PCM诊断的重要性，以防止迟发性治疗和进展为严重表现和不利结果。此外,建议对PCM患者进行HIV调查，尤其是那些非典型和更严重的临床表现。
