CHANGING-ROLE OF INVASIVE ASPERGILLOSIS IN AIDS - A CASE-CONTROL STUDY

Objective: from December 1993 until January 1996 rye observed 10 cases of invasive aspergillosis in a cohort of 140 patients with AIDS (7%), By contrast, no invasive aspergillosis was diagnosed in a cohort of 2 78 patients with AIDS between 1986 until 1993. Methods: case controls were assigned randomly to each patient with invasive aspergillosis fro m the total pool of HIV-infected patients. Patients with invasive aspe rgillosis were studied retrospectively by matched-pairs analysis with respect to risk factors, radiological, microbiological and autopsy fin dings. Results: patients with aspergillosis had more AIDS-defining eve nts (3.5 [2-5] vs. 2 [2-3], median [range], P<0.05) and a longer media n survival time with full-blown AIDS (31.5 [14-45] months vs. 20.5 [5- 32] months, P<0.005) than their case controls. Patients with invasive aspergillosis tended to have lower white blood cell counts and exhibit ed significantly decreased median CD4 counts (7 [0-44]/mm(3) vs. 27 [8 -57]/mm(3), P<0.05). Conclusions: due to better management of opportun istic diseases and improved antiretroviral therapy, the lifespan of pa tients with full blown AIDS is prolonged, Patients who have survived f our or more AIDS-defining events are at risk for invasive aspergillosi s. This risk is associated with low white blood cell counts and CD4 ce ll counts.