INVASIVE ASPERGILLOSIS IN AIDS

Risk factor for invasive pulmonary aspergillosis in HIV-negative patie nts include neutropenia, corticosteroid therapy, and chemotherapy. Cor responding risk factors in HIV-positive patients have not yet been rep orted. A case-control study was conducted at the Bichat-Claude Bernard Teaching Hospital, Paris, France, between 1991 and 1996. Eight cases were identified. In three cases, the diagnosis was documented histolog ically. Of the remaining five patients, four had a ne novo lung cavity with a positive bronchoscopy sample, and one had a pulmonary infiltra te with a positive bronchoscopy sample in the absence of any other pot ential pathogen. Each case was matched with three controls who were ad mitted during the same period and had CD4 counts lower than 50/mm(3). Median age was 38.1 years in the cases and 38.1 years in the controls. Median CD4 counts were 12.5+/-19.2 in the cases versus 19.3+/-16.3 in the controls (P=0.14). No case-control differences were found for AID S duration, neutrophil counts at diagnosis or during the previous six months, history of corticosteroid therapy or chemotherapy, or number o f previous opportunistic infections. Cases were more likely than contr ols to have a preexisting lung cavity (3/8 versus 0/24; P=0.01) and ha d spent more time in the hospital during the previous year (7+/-4.5 ve rsus 2,8+/- 3.2 weeks; P=0.02), These data do not support a role for n eutropenia or immunosuppressive treatments as risk factors for invasiv e aspergillosis in AIDS. They suggest that AIDS patients with a lung c avity or frequent hospital stays are at increased risk for invasive as pergillosis.