PULMONARY ASPERGILLOMA AND AIDS - A COMPARISON OF HIV-INFECTED AND HIV-NEGATIVE INDIVIDUALS

Objective and methods: While pulmonary aspergilloma has been well desc ribed in immunocompetent hosts, to date and to our knowledge, there ha s not been a description of pulmonary aspergilloma in the HIV-infected individual. A retrospective review of cases seen by the Bellevue Hosp ital Chest Service from January 1992 through June 1995 identified 25 p atients with aspergilloma. To investigate the impact of HIV status on pulmonary aspergilloma, we compared clinical presentation, progression of disease, treatment, and outcome in the HIV-infected patient vs the HIV-negative patient with aspergilloma. Results: Of the 25 patients i dentified, 10 were HIV-infected and 15 were HIV-negative. Predisposing diseases included tuberculosis (18/25, 72%), sarcoidosis (4/25, 16%), and Pneumocystis carinii pneumonia (3/25, 12%). All 25 patients had e vidence of aspergilloma on chest CT. In addition, 17 of 25 patients ha d evidence of Aspergillus species in fungal culture, pathologic specim ens, or immunoprecipitins. Hemoptysis was present in 15 of 25 (60%) (1 1/15 [73%] of the HIV-negative group vs 4/10 [40%] of the HIV-infected group). Severe hemoptysis (>150 mL/d) occurred in 5 of 15 (33%) of th e HIV-negative group vs 1 of 10 (10%) of the HIV-infected group. Disea se progression occurred more frequently among the HIV-infected group ( 4/8, 50% vs 1/13, 8% in HIV-negative individuals). All patients with d isease progression had lymphocyte subset CD4+ <100 cells per microlite r. Four of eight (50%) of the HIV-infected group vs 1 of 13 (8%) of th e HIV-negative group died. Summary and conclusions: We conclude the fo llowing: (1) although tuberculosis and sarcoidosis are the most preval ent predisposing diseases, P carinii pneumonia in the HIV-infected ind ividual is a risk factor for pulmonary aspergilloma; (2) HIV-infected individuals with CD4+ <100 cells per microliter are more likely to hav e disease progression despite treatment; and (3) HIV-negative patients are more likely to have hemoptysis requiring intervention.