Changing role of invasive aspergillosis in AIDS--a case control study.
OBJECTIVE
From December 1993 until January 1996 we 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 278 patients with AIDS between 1986 until 1993.


METHODS
Case controls were assigned randomly to each patient with invasive aspergillosis from the total pool of HIV-infected patients. Patients with invasive aspergillosis were studied retrospectively by matched-pairs analysis with respect to risk factors, radiological, microbiological and autopsy findings.


RESULTS
Patients with aspergillosis had more AIDS-defining events (3.5 [2-5] vs. 2 [2-3], median [range], P < 0.05) and a longer median 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 exhibited significantly decreased median CD4 counts (7 [0-44]/mm3 vs. 27 [8-57]/mm3, P < 0.05).


CONCLUSIONS
Due to better management of opportunistic diseases and improved antiretroviral therapy, the lifespan of patients with full blown AIDS is prolonged. Patients who have survived four or more AIDS-defining events are at risk for invasive aspergillosis. This risk is associated with low white blood cell counts and CD4 cell counts.
Woitas
R P
RP
Department of General Internal Medicine, University of Bonn, Germany.
Rockstroh
J K
JK
Theisen
A
A
Leutner
C
C
Sauerbruch
T
T
Spengler
U
U
D017088:AIDS-Related Opportunistic Infections / Q000276:immunology* / Q000401:mortality; D000163:Acquired Immunodeficiency Syndrome / Q000276:immunology* / Q000401:mortality; D000328:Adult; D001228:Aspergillosis / Q000276:immunology* / Q000401:mortality; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors