Inclusion Criteria

Concurrent Medication:

Itraconazole therapy must begin no more than 6 weeks after discontinuing primary amphotericin B therapy; itraconazole therapy may begin immediately after stopping the primary therapy with amphotericin B.

Allowed:

• Oral contraceptives.
• Methadone.
• Narcotics.
• Acyclovir.
• Acetaminophen.
• Sulfonamides.
• Trimethoprim / sulfamethoxazole.
• Aerosolized pentamidine for Pneumocystis carinii pneumonia (PCP) or PCP prophylaxis (patients with a total CD4+ count < 200 or a history of PCP should receive PCP prophylaxis).
• Treatment IND drugs.
• Zidovudine.
• Topical antifungals.
• Discouraged:
• Antacids.
• Sucralfate.
• H2 blockers.

Concurrent Treatment:

Allowed:

• Radiation therapy for mucocutaneous Kaposi's sarcoma.

Prior Medication:

Required:

• Prior treatment with amphotericin B for disseminated histoplasmosis:
• minimum total dose of 15 mg/kg for patients < 67 kg, or 1 g for patients > 67 kg; must have been administered over 6 months or less.

Allowed:

• Amphotericin B as maintenance therapy for a maximum of 6 weeks following completion of primary therapy.
• Zidovudine.
• Prophylaxis for Pneumocystis carinii pneumonia.

Exclusion Criteria

Co-existing Condition:

Patients with the following conditions are excluded:

• History of allergy to, or intolerance of, imidazoles or azoles.
• Clinical findings of active histoplasmosis.
• Histoplasmosis of the central nervous system.
• Inability to take oral medications reliably or severe malabsorption syndrome.
• Malignancies requiring cytotoxic therapy.
• Culture-proven systemic Mycobacterium tuberculosis, Mycobacterium avium-intracellulare, coccidioidomycosis, or cryptococcosis.

Concurrent Medication:

Excluded:

• Amphotericin B as maintenance therapy.
• Immunostimulants.
• Ketoconazole.
• Systemic antifungals.
• Steroids in excess of physiologic replacement doses.
• Cytotoxic chemotherapy.
• Investigational agents not specifically allowed.
• Antacids for 4 hours before and 4 hours after itraconazole.

Concurrent Treatment:

Excluded:

• Lymphocyte replacement.

Patients with the following conditions are excluded:

• History of allergy to, or intolerance of, imidazoles or azoles.
• Clinical findings of active histoplasmosis.
• Histoplasmosis of the central nervous system.
• Inability to take oral medications reliably or severe malabsorption syndrome.
• Malignancies requiring cytotoxic therapy.
• Culture-proven systemic Mycobacterium tuberculosis, Mycobacterium avium-intracellulare, coccidioidomycosis, or cryptococcosis.

Prior Medication:

Excluded within 30 days of study entry:

• Immunostimulants.
• Ketoconazole.
• Systemic antifungals.
• Steroids in excess of physiologic replacement doses.
• Cytotoxic chemotherapy.

Prior Treatment:

Excluded:

• Lymphocyte replacement.

Risk Behavior:

Excluded:

• Patients who in the opinion of the investigator would be undependable with regard to adherence to protocol.

Inclusion criteria are:

• HIV infection documented by presence of antibody, by ELISA with Western blot confirmation, or serum p24 antigen, or by recovery of HIV in culture.
• Acute first episode of disseminated histoplasmosis documented by recovery and identification of H. capsulatum from cultures obtained from extrapulmonary sites.
• Oriented to person, place, and time, and able to give written informed consent.