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Case 8: A 27-Year-Old Man with AIDS and Disseminated Histoplasmosis

You answered:

D During maintenance therapy, obtaining Histoplasma antigen levels is not recommended because they have no value in monitoring for relapse.

This answer is incorrect. There is evidence that checking Histoplasma antigen levels in serum and urine periodically is an effective way to monitor for disease relapse. Antigen levels increase in approximately 90% of patients who suffer a relapse.

A The preferred initial therapy for HIV-infected patients with progressive severe disseminated histoplasmosis is itraconazole (Sporanox).
B If the patient does not tolerate itraconazole for maintenance therapy, fluconazole (Diflucan) can be used and expected to have the same rate of fungal suppression and relapse.
C For patients taking itraconazole maintenance therapy, serum itraconazole levels should be monitored, at least initially.


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