Histoplasmosis is a high-morbidity and high-mortality opportunistic fungal infection among people living with HIV, particularly in endemic regions. Hepatic and renal dysfunctions are frequently observed in these patients and may negatively affect clinical outcomes. This study aimed to evaluate the association between hepatic and renal dysfunctions and mortality in patients with HIV and suspected histoplasmosis, analyzing whether these alterations influenced outcomes differently in groups with and without confirmed infection.

Cross-sectional study using data obtained from medical records of 71 HIV-positive patients with clinical suspicion of histoplasmosis who underwent urinary antigen testing. Patients were classified into four groups: death with confirmed histoplasmosis (Ag+), death without confirmation (Ag−), hospital discharge Ag+, and discharge Ag−. Renal/hepatic alterations were assessed using urea, creatinine, AST, ALT, alkaline phosphatase, GGT, INR, and albumin levels. Estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI equation from the Brazilian Society of Nephrology. Descriptive analyses and Fisher’s exact test were used to evaluate associations between these alterations and death, with statistical significance set at p < 0.05.

Among the evaluated patients, most were male (74.7%) with a mean age of 39.3 years. Patients presented varying degrees of renal and hepatic dysfunction. Renal alterations were more frequent among patients who died in the Ag− group (57.9%) and also prevalent among deaths in the Ag+ group (50%), although no statistically significant association with mortality was observed in either group (Ag+ p = 1.00; Ag− p = 0.23). Hepatic alterations were universal in Ag− patients (both death and discharge). In the Ag+ group, hepatic dysfunction was more frequent among survivors (100%) than among those who died (70%). The presence of hepatic alterations in the Ag+ group showed a statistically significant association with mortality (p = 0.037). In the Ag− group, the test could not be applied due to lack of variability.

Hepatic dysfunction was associated with poorer prognosis among HIV-positive patients with confirmed histoplasmosis. These findings underscore the importance of early hepatic function assessment as a potential severity marker and prognostic factor in the clinical management of these patients.