RISK-FACTORS AND OUTCOMES ASSOCIATED WITH IDENTIFICATION OF ASPERGILLUS IN RESPIRATORY SPECIMENS FROM PERSONS WITH HIV DISEASE

Study objectives: To examine the significance of previously suggested risk factors and assess outcomes associated with Aspergillus identific ation in respiratory specimens from HIV-seropositive individuals. Desi gn: This was a nested case-control study, Patients who had Aspergillus species identified in respiratory specimens were matched at the time of study entry 1:2 with control subjects according to study center, ag e, gender, race, HIV transmission category, and CD4 count, Setting: Th e multicenter Pulmonary Complications of HIV Infection Study. Particip ants: HIV-seropositive study participants, Measurements and results: B etween November 1988 and March 1994, Aspergillus species were detected in respiratory specimens from 19 (1,6%) participants, The rate of Asp ergillus identification among participants with CD4 counts <200 cells per cubic millimeter during years 2 through 5 after study entry ranged from 1.2 to 1.9%. Neutropenia, a CD4 count <30 cells per cubic millim eter, corticosteroid use, and Pneumocystis carinii infection were asso ciated with subsequent identification of Aspergillus in respiratory sp ecimens. Cigarette and marijuana use, previously suggested risk factor s, were not associated with Aspergillus respiratory infection, A subst antially greater proportion of patients with Aspergillus compared with control subjects died during the study (90% vs 21%). Excluding four c ases first diagnosed at autopsy, 67% died within 60 days after Aspergi llus was detected. Conclusions: Although Aspergillus is infrequently i solated from HIV-infected persons, the associated high mortality would support serious consideration of its clinical significance in those w ith advanced disease and risk factors.