{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T08:02:05Z","timestamp":1784880125112,"version":"3.55.0"},"reference-count":33,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000027","name":"National Institute on Alcohol Abuse and Alcoholism","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000027","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Histoplasmosis remains a significant cause of morbidity and mortality in people with HIV . We examined disseminated histoplasmosis incidence, risk factors, and outcomes from North and South American HIV clinical sites.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Cohorts from Brazil, Chile, Honduras, Mexico, Peru and the United States (Tennessee) contributed data on PLWH \u226518 years old from 2000 to 2021. Stratifying by US and Latin American cohorts, we examined diagnosed disseminated histoplasmosis incidence and risk factors with modified Poisson regression models. Cox proportional hazard models examined factors associated with mortality after histoplasmosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 26,672 people with HIV (Latin America\n                      <jats:italic>n<\/jats:italic>\n                      = 19,836; United States\n                      <jats:italic>n<\/jats:italic>\n                      = 6836), 214 had incident histoplasmosis(Latin America\u00a0\n                      <jats:italic>n<\/jats:italic>\n                      = 140; United States\n                      <jats:italic>n<\/jats:italic>\n                      = 74). From 2000 to 2021, histoplasmosis incidence decreased from 16.08 to 0.93 in Latin America and 13.4 to 0.67 per 1000 person\u2010years in the United States. In Latin America, histoplasmosis risk was higher for males (aRR = 2.50 [95% CI: 1.62\u22123.86]), pre\u2010antiretroviral therapy initiation (aRR = 7.76 [95% CI: 5.05\u221211.90]) and those who had migrated from a histoplasma\u2010endemic country (aRR = 6.12 [95% CI: 1.81\u221220.69]). Risk was also higher for older people with HIV, those with low CD4, earlier calendar year and differed by site. In the United States, risk was higher in people with HIV with low CD4, higher HIV viral load, earlier calendar year and pre\u2010antiretroviral therapy initiation (aRR = 2.65 [95% CI: 1.11\u22126.36]). Mortality after histoplasmosis was higher in people with HIV with an earlier year of histoplasmosis 2000 versus 2010 (aHR = 2.00 [95% CI: 1.26\u22123.17]) and among those who developed histoplasmosis after antiretroviral therapy initiation compared to before antiretroviral therapy (aHR = 2.66 [95% CI: 1.43\u22124.95]).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite concern for underdiagnosis of disseminated histoplasmosis in Latin America, its incidence in people with HIV decreased, as it did in the United States. Low CD4 cell count and time before antiretroviral therapy initiation remain strongly associated with histoplasmosis risk. Further attention to early HIV diagnosis and treatment is needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jia2.70160","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T06:00:18Z","timestamp":1783663218000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Trends in Incidence and Risk Factors of HIV\u2010Associated Disseminated Histoplasmosis in the Americas: An Observational Cohort Study"],"prefix":"10.1002","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4404-8076","authenticated-orcid":false,"given":"Ashley","family":"Zeoli","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paridhi","family":"Ranadive","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodrigo","family":"Ville","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n Salvador Zubir\u00e1n  Mexico City Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Castillo\u2010Rozas","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3n Arriar\u00e1n and University of Chile  Santiago Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pablo F.","family":"Belaunzar\u00e1n\u2010Zamudio","sequence":"additional","affiliation":[{"name":"Division of AIDS, National Institute of Allergy &amp; Infectious Diseases [Contractor]  Rockville Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valdil\u00e9a G.","family":"Veloso","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Infectologia Evandro Chagas\u2010Fiocruz  Rio de Janeiro Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisy M.","family":"Machado","sequence":"additional","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo  Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco Tulio","family":"Luque","sequence":"additional","affiliation":[{"name":"Instituto Hondure\u00f1o de Seguridad Social and Hospital Escuela Universitario  Tegucigalpa Honduras"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Gotuzzo","sequence":"additional","affiliation":[{"name":"Instituto De Medicina Tropical Alexander von Humboldt Universidad Peruana Cayetano Heredia  Lima Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4674-7903","authenticated-orcid":false,"given":"Juli\u00e1n","family":"Garcia","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3n Hu\u00e9sped Investigaciones Cl\u00ednicas  Buenos Aires Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy R.","family":"Sterling","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan E.","family":"Shepherd","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica L.","family":"Castilho","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Caribbean, Central and South America network for HIV epidemiology (CCASAnet)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12281-011-0081-7"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciac882"},{"key":"e_1_2_12_4_1","doi-asserted-by":"crossref","unstructured":"J. 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