TY - JOUR
T1 - Fungal biomarkers in HIV-associated disseminated histoplasmosis
T2 - a multicenter diagnostic accuracy study on the Guiana shield
AU - Moussiegt, Aurore
AU - Donald, Sigrid Mac
AU - Bougnoux, Marie Elisabeth
AU - Van Eer, Marja
AU - Vreden, Stephen
AU - Chiller, Tom
AU - Caceres, Diego H.
AU - Gomez, Beatriz L.
AU - Nacher, Mathieu
AU - Lortholary, Olivier
AU - Adenis, Antoine
N1 - Publisher Copyright:
© 2024 The Authors
PY - 2025/4
Y1 - 2025/4
N2 - Objectives: Diagnosis of HIV-associated histoplasmosis remains challenging. Our objective was to compare the performances of (1→3)-β-D-Glucan (BDG) and aspergillus galactomannan (GM) antigen for the diagnosis of HIV-associated histoplasmosis. Methods: We performed a diagnostic accuracy study using frozen primary serum specimens issued from consecutive hospitalized people living with HIV (PLWH) and blindly tested for BDG and GM using FungitellⓇ and PlateliaTM Aspergillus, respectively. Results: We included 121 sera with 92 HIV-associated histoplasmosis cases and 29 negative controls. At thresholds of 150 pg/ml and 0.5 for BDG and GM, the sensitivity and specificity were 95% (85-100) vs 90% (77-100) and 52% (34-70) vs 83% (69-97), respectively. The receiver operating characteristics (ROC) curves showed area under the curves of 0.82 (0.68-0.91) vs 0.92 (0.80-0.98) for BDG and GM, respectively. Post-test probabilities showed best performances at lowest thresholds for a negative testing of BDG and GM and at the 0.7 threshold for a positive GM test. Conclusions: If BDG alone may rule out histoplasmosis when negative, GM alone, either positive or negative, showed the best performances for the diagnosis of histoplasmosis. Given the poorer performances of BDG and GM than Histoplasma antigen detection assays commercially available, they should be considered as an alternative in settings where Histoplasma antigen detection assays remain unavailable. However, this study essentially provides insights in the performances of fungal biomarkers in disseminated histoplasmosis and does not represent recommendations for best practices.
AB - Objectives: Diagnosis of HIV-associated histoplasmosis remains challenging. Our objective was to compare the performances of (1→3)-β-D-Glucan (BDG) and aspergillus galactomannan (GM) antigen for the diagnosis of HIV-associated histoplasmosis. Methods: We performed a diagnostic accuracy study using frozen primary serum specimens issued from consecutive hospitalized people living with HIV (PLWH) and blindly tested for BDG and GM using FungitellⓇ and PlateliaTM Aspergillus, respectively. Results: We included 121 sera with 92 HIV-associated histoplasmosis cases and 29 negative controls. At thresholds of 150 pg/ml and 0.5 for BDG and GM, the sensitivity and specificity were 95% (85-100) vs 90% (77-100) and 52% (34-70) vs 83% (69-97), respectively. The receiver operating characteristics (ROC) curves showed area under the curves of 0.82 (0.68-0.91) vs 0.92 (0.80-0.98) for BDG and GM, respectively. Post-test probabilities showed best performances at lowest thresholds for a negative testing of BDG and GM and at the 0.7 threshold for a positive GM test. Conclusions: If BDG alone may rule out histoplasmosis when negative, GM alone, either positive or negative, showed the best performances for the diagnosis of histoplasmosis. Given the poorer performances of BDG and GM than Histoplasma antigen detection assays commercially available, they should be considered as an alternative in settings where Histoplasma antigen detection assays remain unavailable. However, this study essentially provides insights in the performances of fungal biomarkers in disseminated histoplasmosis and does not represent recommendations for best practices.
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U2 - 10.1016/j.ijid.2024.107360
DO - 10.1016/j.ijid.2024.107360
M3 - Research Article
C2 - 39672535
AN - SCOPUS:85214556910
SN - 1201-9712
VL - 153
JO - International Journal of Infectious Diseases
JF - International Journal of Infectious Diseases
M1 - 107360
ER -