Relação entre achados radiológicos pulmonares e sintomas clínicos em pacientes com coinfecção por HIV e histoplasmose: uma análise comparativa em diferentes regimes terapêuticos

Abstract

Disseminated histoplasmosis (DH) is one of the opportunistic fungal infections with the highest morbidity and mortality among people living with HIV/AIDS (PLWHA) in Latin America. Chest computed tomography (CT) represents an important complementary tool in the initial evaluation of these patients, especially when specific diagnostic methods are unavailable; however, the relationship between tomographic patterns and clinical severity remains insufficiently investigated. This study investigated the relationship between pulmonary tomographic findings and respiratory clinical manifestations in patients coinfected with HIV and DH undergoing different liposomal amphotericin B regimens, in addition to describing the baseline demographic, clinical, laboratory, and radiological profile of the cohort. This was an observational, analytical, and retrospective study consisting of a secondary analysis of baseline data from a phase II randomized clinical trial conducted at Brazilian referral centers. Forty-five adult patients with HIV/AIDS and confirmed DH diagnosis were included. Clinical, laboratory, and radiological variables were analyzed descriptively. Associations between tomographic findings and respiratory symptoms were assessed using Fisher’s exact test or Pearson’s chi-square test, with calculation of odds ratios (OR) and 95% confidence intervals (95% CI). The median age was 38 years, with predominance of male patients (68.9%). The median CD4+ T-lymphocyte count was 22 cells/mm³, and 83.7% of patients presented values below 50 cells/mm³. Fever and weight loss greater than 15% were present in 90.9% and 93.2% of cases, respectively. Respiratory involvement was the most frequent manifestation (80.0%), followed by oral lesions (55.8%), lymphadenomegaly (50.0%), cutaneous lesions (42.9%), gastrointestinal manifestations (27.3%), and neurological manifestations (15.9%). Laboratory findings demonstrated anemia, leukopenia, thrombocytopenia, hyponatremia, and marked elevation of ferritin and LDH levels. The most frequent tomographic findings were micronodular/nodular opacities (46.3%), ground-glass opacities (26.8%), and consolidations (26.8%). No statistically significant associations were identified between the evaluated tomographic patterns and respiratory symptoms at admission. The cohort presented profound immunosuppression, multisystem involvement, and laboratory findings compatible with severe disseminated disease. The absence of association between tomographic findings and respiratory symptoms was physiopathologically plausible in the context of profound immunosuppression, in which attenuation of the local inflammatory response may dissociate the extent of radiological involvement from the intensity of clinical symptoms. Normal chest CT findings in 9.8% of patients with confirmed diagnosis reinforce that negative imaging does not exclude active infection. The results support the use of chest CT as a complementary assessment tool rather than as an isolated instrument for screening or severity stratification in this population.