This study compared the clinical presentations of 58 episodes of
cryptococcosis in 50 patients and 26 episodes of penicillosis in 25 patients infected with human immunodeficiency virus (HIV) between June 1994 and June 2004, and assessed the safety of discontinuation of secondary prophylaxis for endemic
fungal infections in those patients responding to highly active anti-retroviral
therapy (
HAART). Neurological symptoms were seen more commonly in patients with
cryptococcosis, whereas respiratory symptoms,
lymphadenopathy,
hepatomegaly and/or
splenomegaly, and non-
thrush-related oral presentations were seen more commonly in patients with penicillosis. Patients with penicillosis were more likely to have abnormal chest radiography results and radiographic presentations of interstitial lesions, cavitations, fibrotic lesions and mass lesions. At the end of the study, maintenance antifungal
therapy had been discontinued in 27 patients with
cryptococcosis and in 18 patients with penicillosis in whom the median CD4 count had increased to 186 cells/microL (range, 9-523 cells/microL) and 95 cells/microL (range, 15-359 cells/microL), respectively, after
HAART. Only one episode of penicillosis recurred (a relapse rate of 1.72/100 person-years; 95% CI, 1.44-2.10/100 person-years) after a median follow-up duration of 35.3 months (range, 2.6-91.6 months). No relapses occurred in patients with
cryptococcosis after a median follow-up duration of 22.3 months (range, 1-83.4 months). These findings suggest that there are differences in the clinical presentations between endemic
cryptococcosis and penicillosis in patients with
HIV infection, and that it is safe to discontinue secondary antifungal prophylaxis for
cryptococcosis and penicillosis in patients responding to
HAART.