The frequency of disseminated histoplasmosis (DH) and tuberculosis (TB) coinfection among people living with HIV/AIDS (PLWHA) in Brazil ranges from 11% to 26%. This study aimed to evaluate the impact and factors associated with DH/TB coinfection in PLWHA between 2020 and 2024 at a hospital center in Northeastern Brazil.

Retrospective cohort study of hospitalized patients diagnosed with DH, followed for 90 days. The primary outcome was TB diagnosis. PLWHA aged ≥18 years with confirmed DH (isolation of Histoplasma capsulatum from buffy coat culture) or probable DH (positive urinary galactomannan antigen test) were included. TB diagnosis was established by rapid molecular testing or positivity of urinary lipoarabinomannan antigen testing. Statistical analysis was performed using STATA 18.0 software.

During the study period, 251 patients were hospitalized with DH. The incidence of DH/TB coinfection was 19.5% (n = 49). Most patients were male. Median age (38.7 DH vs. 35.7 DH/TB; p = 0.053), CD4+ count (52 DH vs. 54.2 DH/TB; p = 0.689), and HIV viral load log (5.12 DH vs. 5.34 DH/TB; p = 0.841) were similar between groups. DH as an AIDS-defining illness (35.6% vs. 65.4%; p < 0.001) and previous TB history (6.4% vs. 65.3%; p < 0.001) occurred mainly in the coinfection group. Recent antiretroviral therapy use occurred in 8.91% of the DH group and 4.08% of the DH/TB group (p = 0.382). Dyspnea was more frequent in the DH/TB group (51% vs. 35.1%; p = 0.040), as was higher total serum bilirubin (1.8 vs. 1.3 mg/dL; p = 0.047). Itraconazole use was more frequent in the DH group (47% vs. 24.5%; p = 0.004). Mortality frequency was similar between groups (25.7% DH vs. 34.7% DH/TB; p = 0.208). Ninety-day survival was 74.3% in the DH group and 64.8% in the DH/TB group (p = 0.267). In Poisson regression analysis, prior TB history was an independent factor associated with DH/TB coinfection (p < 0.001).

The impact of coinfection on patient survival was similar to that observed in DH alone. However, patients with a prior history of TB should be closely monitored for the risk of coinfection in the setting of advanced HIV disease. Long-term studies are needed to assess the impact of coinfection treatment on survival in PLWHA.