Cutting antifungal therapy short may be safer than guidelines suggest

For immunocompromised patients with histoplasmosis, stopping antifungal treatment before the guideline-recommended 12 months may not be as risky as previously thought. A retrospective cohort study of 106 patients found that relapse was uncommon overall — occurring in just 6.6% of cases — and that shorter treatment duration was not statistically associated with a higher risk of histoplasmosis-related adverse outcomes.

The study tracked patients treated between 2005 and 2025, comparing those who completed at least 12 months of therapy (74%) with those who stopped earlier (26%). Median follow-up exceeded 1,300 days in both groups, and no histoplasmosis-related deaths occurred in either cohort.

By the Numbers:

• 6.6% overall relapse rate across all patients
• 12% relapse rate in the shorter-duration group vs. 5.5% in the guideline-based group (not statistically significant)
• Rehospitalization was higher in the shorter-duration group: 80% vs. 52.1%
• Patients with antigen levels of 10.1–20 ng/mL had significantly lower odds of adverse events vs. those with levels >20 ng/mL

Why it matters: These findings suggest that baseline disease burden — reflected by antigen levels at diagnosis — may be a better guide for treatment duration decisions than a fixed 12-month rule, potentially allowing more personalized, flexible management for immunocompromised patients.