Aspergillosis in HIV patients: a case series

Abstract

PurposeAspergillosis is uncommon in HIV patients and has been mostly reported in patients with CD4<50/µL. Data on risk factors and prognosis are scarce. We reviewed 19 cases of aspergillosis diagnosed in our HIV cohort.MethodsIn the Brussels Saint‐Pierre HIV cohort, 19 patients were diagnosed with aspergillosis between 1998 and 2012 (0.87/1000 patient/year of follow‐up). We analyzed retrospectively and described localization and invasiveness of aspergillosis, risk factors, treatment and outcome of these patients.ResultsPatients were mostly African (74%) and mean age was 40 years (22–60). Clinical presentation were 10 invasive aspergillosis (IA) (53%), 6 pulmonary aspergilloma (31%) and 3 sinus fungal ball (16%). The global mortality was 42%. IA was proven for 3 patients, probable for 4 patients and possible for 3 patients according to IDSA definitions. Risk factors for IA included CD4<200/µL (70%; 40%<50 CD4/µL), corticotherapy (50%), neutropenia (20%), intravenous drug use (20%), cirrhosis (20%). IA arose in the time course of septic shock in 30% and opportunistic infections occurred concomitantly in 40%. Seven patients out of 10 with IA died including 3 patients before antifungal therapy. The 3 survivors recovered without relapse. Four patients were treated with voriconazole, 2 with itraconazole, 2 with liposomal amphotericine, 1 with caspofungine, and 2 with bitherapy. Among patients with aspergilloma (n=6), the major associated risk factor was tuberculosis sequelae (80%). Two patients were successfully treated with surgery and voriconazole, 1 died from massive hemoptysis, 2 were lost to follow‐up, 1 is currently asymptomatic without treatment. Among patients with sinus fungal ball (n=3), all recovered without relapse with surgical treatment associated with voriconazole for one.ConclusionIncidence of aspergillosis in HIV patients remains low but in accordance to previous reports, mortality of IA is high (70%). CD4<200 is the most common risk factor (70%) but 80% of patients who died had other risk factors, mostly corticotherapy. IA is often concomitant with other infectious diseases (40% with other opportunistic infections and 30% in the time course of septic shock), which can potentially delay diagnosis. Prognosis of pulmonary aspergilloma and sinus fungal ball is better.