Histoplasmosis Test Results

Feb 8, 2004

Hi, I was diagnosed with HIV last year after being hospitalized for what turned out to be Disseminated Histoplasmosis. After a few weeks of IV antifungal I was put on 400mg of Intraconazole a day. I recently had an antigen test done and the result was a positive 6 unit. My doctor was very vague about the meaning of this number stating he wanted to switch me from the Inteconazole capsule to oral solution for better absorbtion. I asked a few times what the scale is in reference to "6" and all he told me was he was concerned and it was diddicult to explain. Now I am freaking out. Is this a relapse? I have no physical symptoms like when I was hospitalized,(mouth and intestinal lesions, fever, chills and weight loss). The last test he did was about 6 months ago and told me it was "fine". I am on HAART and my viral load is undetectable and CD4 is 240(from an original 65 when I was Diagnosed). Can you help me in interpreting the antigen test? I am scheduled to have another done in 3 weeks. Thanks, Steve

Response from Dr. Holodniy

In these kinds of fungal infections we look for a significant decline in antigen level, say a 50% reduction or a 4-fold (4 times) reduction. Thus, it would be helpful to know what your baseline antigen level was. If it was 10-12 or more, than you have had a significant reduction. However, a level of 6 might indicate some residual activity of the infection, in which case treatment modification (like an increased dose, different preparation or different drug) would be reasonable to do. Some people don't ever get to a level of zero, and depending on what their CD4 count is, might have to be on chronic treatment.