title: Relevance of EORTC Criteria for the Diagnosis of Invasive Aspergillosis in HIV-Infected Patients, and Survival Trends Over a 20-Year Period in France.
abstract: BACKGROUND
  Before the advent of combination antiretroviral therapy (cART), roughly 50% of cases of invasive aspergillosis (IA) associated with human immunodeficiency virus (HIV) infection involved individuals without classical predisposing host factors, and the median survival time was <4 months after diagnosis. We examined if the situation evolved over time using the revised European Organisation for Research and Treatment of Cancer/National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC) definition and analyzed survival trends after diagnosis over 20 years.
  
  
  METHODS
  A data review committee evaluated 342 medical records that mentioned IA in the French Hospital Database on HIV. Validated cases were classified as fulfilling the EORTC criteria or otherwise as "HIV-related IA." Three periods were analyzed: pre-cART (before 1996), cART era prevoriconazole (1996-2001), and 2002-2011.
  
  
  RESULTS
  Among 242 validated cases of IA, 124 (51%) fulfilled the EORTC criteria (EORTC-IA) and 118 (49%) were classified as "HIV-related," with similarly low CD4 cell counts in both groups. The proportion of EORTC-IA cases remained stable across the 3 periods (50%, 48%, and 54%, respectively). The 3-month survival rate improved after the advent of cART (38% vs 69%), with no difference between EORTC-IA and HIV-related IA (hazard ratio [HR], 1.2 95% confidence interval [CI] {0.7-1.8}). Voriconazole exposure decreased mortality in 2002-2011 (HR, 0.1 95% CI [0.01-0.8]).
  
  
  CONCLUSIONS
  In the cART era, EORTC criteria, developed for use in hematology/oncology, still applied to only half the cases diagnosed among HIV-infected patients. A rapid diagnosis of IA is paramount to improve survival. For patients who do not fulfill the EORTC definition, we suggest that the addition of "HIV infected with a CD4 count <100 cells/µL" to the EORTC host criteria be validated.
authors.affiliation: Sorbonne Universités, Université Pierre Marie Curie Université Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique.
authors.forename: Blandine
authors.initials: B
authors.lastname: Denis
authors.affiliation: Sorbonne Universités, Université Pierre Marie Curie Université Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique.
authors.forename: Marguerite
authors.initials: M
authors.lastname: Guiguet
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Centre Hospitalo-Universitaire (CHU) Saint Louis AP-HP, Université Paris Diderot, Paris.
authors.forename: Nathalie
authors.initials: N
authors.lastname: de Castro
authors.affiliation: AP-HP, CHU Avicenne.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Mechaï
authors.affiliation: CHU Rennes.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Revest
authors.affiliation: AP-HP, CHU Henri Mondor, Créteil.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Melica
authors.affiliation: Sorbonne Universités, Université Pierre Marie Curie Université Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique.
authors.forename: Dominique
authors.initials: D
authors.lastname: Costagliola
authors.affiliation: AP-HP, CHU Necker-Enfants malades, Centre d'Infectiologie Necker Pasteur Université Paris Descartes, Institut Imagine Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques Centre National de la Recherche Scientifique URA3012, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Lortholary
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality; D001230:Aspergillus / Q000187:drug effects / Q000472:pathogenicity; D018791:CD4 Lymphocyte Count; D004359:Drug Therapy, Combination; D005260:Female; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D016016:Proportional Hazards Models; D015996:Survival Rate; D013997:Time Factors; D065819:Voriconazole / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D019380:Anti-HIV Agents; D000935:Antifungal Agents; D065819:Voriconazole
keywords: AIDS; EORTC; aspergillosis; incidence; outcome