One High Dose of Amphotericin B May Be an Effective Induction Therapy for HIV-Related Histoplasmosis

In a phase 2 randomized trial, clinical resolution at 14 days after a 10-mg/kg dose of L-AmB was similar to that for standard therapy with no increase in toxicity.

Current treatment guidelines for disseminated histoplasmosis (DH) in persons with advanced HIV disease recommend an initial 2-week course of intravenous liposomal amphotericin B (L-AmB; 3–5 mg/kg daily). For cryptococcal meningitis, efficacy and safety of a single 10-mg/kg infusion of L-AmB is effective and safe (NEJM JW Infect Dis May 2022 and N Engl J Med 2022; 386:1109). What about DH? Investigators in Brazil conducted a phase 2, open-label, noninferiority randomized trial involving 118 patients to compare a single 10-mg/kg intravenous dose of L-AmB, a two-dose regimen (10 mg/kg followed on day 3 by 5 mg/kg), and standard therapy (3 mg/kg daily for 14 days). All participants subsequently received 1 year of oral itraconazole.

Resolution of…

Reviewing Author

Neil M. Ampel, MD

Disclosures

Editorial BoardsUpToDate

Leadership Positions in Professional SocietiesCoccidioidomycosis Study Group (Past President, Secretary, Treasurer)

Neil M. Ampel, MD

Disclosures

Editorial BoardsUpToDate

Leadership Positions in Professional SocietiesCoccidioidomycosis Study Group (Past President, Secretary, Treasurer)

One High Dose of Amphotericin B May Be an Effective Induction Therapy for HIV-Related Histoplasmosis

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Reviewing Author