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Fungal disease in HIV-infected persons: cryptococcosis, histoplasmosis, and coccidioidomycosis.

The AIDS epidemic has profoundly influenced the expression of deep-seated fungal disease in this country over the past 10 years. Previously an uncommon etiology of life threatening disease, deep-seated fungal infections with Cryptococcus neoformans, Histoplasma capsulatum, and Coccidioides immitis accounted for nearly 3000 AIDS index diagnoses in 1990. As the epidemic matures, symptomatic HIV infection can be expected to rise in areas of endemic fungal infection resulting in further recognition of systemic fungal disease. Although amphotericin B and 5-flucytosine remain the initial treatments of choice for AIDS-associated deep fungal infection, clinical trials evaluating the new triazoles offer hope for more effective prophylaxis and treatment in the future.