{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:32:25Z","timestamp":1792798345420,"version":"4.5.0"},"reference-count":28,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2021,4,1]],"date-time":"2021-04-01T00:00:00Z","timestamp":1617235200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Global Action Fund for Fungal infections and JYLAG Foundation","award":["E.A. received this funding under the proposal: \u201cMinimising HIV deaths through rapid fungal diagnosis and better care in Guatemala\""],"award-info":[{"award-number":["E.A. received this funding under the proposal: \u201cMinimising HIV deaths through rapid fungal diagnosis and better care in Guatemala\""]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Opportunistic infections (OIs) and advanced HIV disease (AHD) contribute to HIV-related mortality. Here, we analyzed the situation of AHD and OIs in a cohort of newly diagnosed HIV patients from Guatemala. We included 2127 adult patients from 13 facilities across the country during 2017 to 2018. Patients were screened for tuberculosis (TB), nontuberculous mycobacteria (NTM), histoplasmosis, and cryptococcal disease, independently of their CD4 cell count. Of the 2127 enrolled patients, 1682 (79.1%) had a CD4 cell count available; of which 52% presented with AHD. Of the Mayan population, 65% had AHD. The overall OI incidence was 21%. Histoplasmosis was the most frequent OI (7.9%), followed by TB (7.1%); 94.4% of these infections occurred in patients with a CD4 &lt; 350 cells\/mm3. Mortality at 180 days was significantly higher in those with OIs than without OIs (29.7% vs. 5.9%, p &lt; 0.0001). In one year, this program decreased the OI mortality by 7% and increased the OI treatment by 5.1%. Early OI diagnosis and appropriate therapy reduced OI mortality among newly diagnosed HIV patients in Guatemala. Screening for OIs should be considered in all newly diagnosed HIV patients who have a CD4 cell count &lt; 350 cells\/mm3 or those without a CD4 cell count available. To improve results, interventions such as early HIV detection and access to flucytosine and liposomal amphotericin B are required.<\/jats:p>","DOI":"10.3390\/jof7040268","type":"journal-article","created":{"date-parts":[[2021,4,1]],"date-time":"2021-04-01T10:44:01Z","timestamp":1617273841000},"page":"268","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":50,"title":["A Rapid Screening Program for Histoplasmosis, Tuberculosis, and Cryptococcosis Reduces Mortality in HIV Patients from Guatemala"],"prefix":"10.3390","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6176-0052","authenticated-orcid":false,"given":"Narda","family":"Medina","sequence":"first","affiliation":[{"name":"Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, 28220 Madrid, Spain"},{"name":"Asociaci\u00f3n de Salud Integral, 01001 Guatemala City, Guatemala"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8651-4405","authenticated-orcid":false,"given":"Ana","family":"Alastruey-Izquierdo","sequence":"additional","affiliation":[{"name":"Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, 28220 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oscar","family":"Bonilla","sequence":"additional","affiliation":[{"name":"Cl\u00ednica Familiar \u201cLuis \u00c1ngel Garc\u00eda\u201d\/Hospital General San Juan de Dios, 01001 Guatemala City, Guatemala"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7409-1388","authenticated-orcid":false,"given":"Osmar","family":"Gamboa","sequence":"additional","affiliation":[{"name":"Asociaci\u00f3n de Salud Integral, 01001 Guatemala City, Guatemala"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danicela","family":"Mercado","sequence":"additional","affiliation":[{"name":"Cl\u00ednica Familiar \u201cLuis \u00c1ngel Garc\u00eda\u201d\/Hospital General San Juan de Dios, 01001 Guatemala City, Guatemala"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan C.","family":"P\u00e9rez","sequence":"additional","affiliation":[{"name":"Cl\u00ednica Familiar \u201cLuis \u00c1ngel Garc\u00eda\u201d\/Hospital General San Juan de Dios, 01001 Guatemala City, Guatemala"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7836-4136","authenticated-orcid":false,"given":"Luis Roberto","family":"Salazar","sequence":"additional","affiliation":[{"name":"Asociaci\u00f3n de Salud Integral, 01001 Guatemala City, Guatemala"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6225-7413","authenticated-orcid":false,"given":"Eduardo","family":"Arathoon","sequence":"additional","affiliation":[{"name":"Asociaci\u00f3n de Salud Integral, 01001 Guatemala City, Guatemala"},{"name":"Cl\u00ednica Familiar \u201cLuis \u00c1ngel Garc\u00eda\u201d\/Hospital General San Juan de Dios, 01001 Guatemala City, Guatemala"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5626-2251","authenticated-orcid":false,"given":"David W.","family":"Denning","sequence":"additional","affiliation":[{"name":"The National Aspergillosis Centre, University Hospital of South Manchester, Manchester M23 9LT, UK"},{"name":"The University of Manchester and Manchester Academic Health Science Centre, Manchester M23 9LT, UK"},{"name":"Global Action Fund for Fungal Infections, 1208 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Luis","family":"Rodriguez-Tudela","sequence":"additional","affiliation":[{"name":"Global Action Fund for Fungal Infections, 1208 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,4,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1595","DOI":"10.1093\/cid\/ciw125","article-title":"Incidence of Opportunistic Infections and the Impact of Antiretroviral Therapy Among HIV-Infected Adults in Low-and Middle-Income Countries: A Systematic Review and Meta-analysis","volume":"62","author":"Low","year":"2016","journal-title":"Clin. 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