COMPARATIVE-ANALYSIS OF PROGNOSTIC INDICATORS OF ASPERGILLOSIS IN HEMATOLOGICAL MALIGNANCIES AND HIV-INFECTION

The objective of this study was to identify the prognostic factors inf luencing the outcome of aspergillosis in two models of immunodeficienc y, namely hematological malignancies and HIV infection. The study is b ased on a 5 year prospective logistic regression analysis of risk fact ors, clinical features, radiological findings and therapy affecting th e prognosis of aspergillosis in 43 patients, i.e. 27 haematological ne oplastic patients (group A) and 16 HIV infected patients (group B). Un ivariate analysis indicated that neutropenia (P=0.02), haemoptysis (P= 0.03) and concomitant AIDS (P=0.02) negatively influenced the prognosi s of aspergillosis. Comparing the two group of patients, significant d ifferences emerged in the prognostic indicators. In particular respira tory failure (P=0.02) and radiological bilateral involvement of the lu ngs were associated with a poor prognosis in group A (P=0.04) and low (<100/mm(3)) T CD4+ cell count in group B (P=0.02). At variance, a bet ter prognosis was documented in patients treated with sequential thera py (amphotericin B and itraconazole) only within the group of haematol ogical patients (P=0.003). On multivariate analysis sequential therapy (P=0.01) and AIDS (P=0.03) were independent prognostic indicators of aspergillosis. In conclusion, our prospective study indicates that asp ergillosis, although an uncommon event in patients with HIV infection, has a more severe prognosis in comparison to haematological patients. Future prospective clinical trials are necessary to confirm the real importance of the sequential therapy, with amphotericin B and intracon azole, in patients with aspergillosis.