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(Chest. 1998;114:131-137.)
© 1998 American College of Chest Physicians

Risk Factors and Outcomes Associated With Identification of Aspergillus in Respiratory Specimens From Persons With HIV Disease

Jeanne Marie Wallace MD, FCCP1; Rosemarie Lim MD2; Ben L. Browdy PhD2; Philip C. Hopewell MD3; Jeffrey Glassroth MD, FCCP4; Mark J. Rosen MD, FCCP5; Lee B. Reichman MD, FCCP6; Paul A. Kvale MD, FCCP7; and ;Pulmonary Complications of HIV Infection Study Group

1 From the Department of Medicine, Olive View-UCLA Medical Center, Sylmar, Calif; University of California, Los Angeles
2 From the University of California, Los Angeles
3 From the University of California, San Francisco
4 From the Medical College of Pennsylvania-Hahnemann Medical School
5 From the Beth Israel Medical Center
6 From the University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark
7 From the Henry Ford Hospital, Detroit

Study objectives: To examine the significance of previously suggested risk factors and assess outcomes associated with Aspergillus identification in respiratory specimens from HIV-seropositive individuals.

Design: 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, age, gender, race, HIV transmission category, and CD4 count.

Setting: The multicenter Pulmonary Complications of HIV Infection Study.

Participants: HIV-seropositive study participants.

Measurements and results: Between November 1988 and March 1994, Aspergillus species were detected in respiratory specimens from 19 (1.6%) participants. The rate of Aspergillus 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 millimeter, corticosteroid use, and Pneumocystis carinii infection were associated with subsequent identification of Aspergillus in respiratory specimens. Cigarette and marijuana use, previously suggested risk factors, were not associated with Aspergillus respiratory infection. A substantially greater proportion of patients with Aspergillus compared with control subjects died during the study (90% vs 21%). Excluding four cases first diagnosed at autopsy, 67% died within 60 days after Aspergillus was detected.

Conclusions: Although Aspergillus is infrequently isolated from HIV-infected persons, the associated high mortality would support serious consideration of its clinical significance in those with advanced disease and risk factors.

Key Words: Aspergillus • HIV • pneumonia

Submitted on August 13, 1997
Accepted on January 13, 1998




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[Abstract] [Full Text] [PDF]


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