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dc.contributor.authorSamayoa, B
dc.contributor.authorAguirre, L
dc.contributor.authorBonilla, O
dc.contributor.authorMedina, N
dc.contributor.authorLau-Bonilla, D
dc.contributor.authorMercado, D
dc.contributor.authorMoller, A
dc.contributor.authorPerez, J C
dc.contributor.authorAlastruey-Izquierdo, Ana 
dc.contributor.authorArathoon, E
dc.contributor.authorDenning, D W
dc.contributor.authorRodriguez-Tudela, Juan Luis
dc.identifier.citationOpen Forum Infect Dis. 2019 Dec 15;7(1):ofz534.es_ES
dc.description.abstractA Diagnostic Laboratory Hub (DLH) was set up in Guatemala to provide opportunistic infection (OI) diagnosis for people with HIV (PWH). Patients newly presenting for HIV, PWH not receiving antiretrovirals (ARVs) for >90 days but returned to care (Return/Restart), and PWH on ARVs with symptoms of OIs (ARV treatment) were prospectively included. Screening for tuberculosis, nontuberculous mycobacteria (NTM), histoplasmosis, and cryptococcosis was done. Samples were couriered to the DLH, and results were transmitted electronically. Demographic, diagnostic results, disease burden, treatment, and follow-up to 180 days were analyzed. In 2017, 1953 patients were included, 923 new HIV infections (an estimated 44% of all new HIV infections in Guatemala), 701 on ARV treatment, and 315 Return/Restart. Three hundred seventeen (16.2%) had an OI: 35.9% tuberculosis, 31.2% histoplasmosis, 18.6% cryptococcosis, 4.4% NTM, and 9.8% coinfections. Histoplasmosis was the most frequent AIDS-defining illness; 51.2% of new patients had <200 CD4 cells/mm3 with a 29.4% OI incidence; 14.3% of OIs in new HIV infections occurred with CD4 counts of 200-350 cells/mm3. OIs were the main risk factor for premature death for new HIV infections. At 180 days, patients with OIs and advanced HIV had 73-fold greater risk of death than those without advanced disease who were OI-free. The DLH OI screening approach provides adequate diagnostic services and obtains relevant data. We propose a CD4 screening threshold of <350 cells/mm3. Mortality remains high, and improved interventions are required, including expansion of the DLH and access to antifungal drugs, especially liposomal amphotericin B and flucytosine.es_ES
dc.description.sponsorshipFinancial support. This work was supported by Global Action Fund for Fungal Infections and JYLAG, a charity Foundation based in Switzerland (E.A. received this funding under the proposal: “Minimising HIV deaths through rapid fungal diagnosis and better care in Guatemala”). Other contributions came from AIDS Health Foundation (AHF) Guatemala, Intrahealth International and Ministry of health in Guatemala (MSPAS).es_ES
dc.publisherOxford University Press es_ES
dc.relation.isversionofPublisher's versiones_ES
dc.subjectOpportunistic infectionses_ES
dc.titleThe Diagnostic Laboratory Hub: A New Health Care System Reveals the Incidence and Mortality of Tuberculosis, Histoplasmosis, and Cryptococcosis of PWH in Guatemala.es_ES
dc.rights.licenseAttribution-NonCommercial-NoDerivatives 4.0 Internacional*
dc.contributor.funderGlobal Action Fund for Fungal Infections
dc.identifier.journalOpen forum infectious diseaseses_ES
dc.repisalud.centroISCIII::Centro Nacional de Microbiologíaes_ES

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Attribution-NonCommercial-NoDerivatives 4.0 Internacional
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