Pulmonary aspergillosis and invasive disease in AIDS: Review of 342 cases

Aspergillosis is an infrequent but commonly fatal infection among HIV- infected individuals. We review 342 cases of pulmonary Aspergillus infection that have been reported among HIV-infected patients, with a focus on invasive diseases, Invasive pulmonary aspergillosis usually occurs among patients with <50 CD4 cells/mm³. Major predisposing conditions include neutropenia and steroid treatment. Fever, cough, and dyspnea are each present in >60% of the cases. BAL is often suggestive, but biopsy specimens are necessary for definite diagnosis. Amphotericin B is the mainstay of treatment and morality is >80%. Avoiding neutropenia and judicious use of steroids may be helpful in prevention. Aggressive diagnostic approach, early initiation of treatment, adequate dosing of antifungals, and close follow-up may improve the currently dismal prognosis.