Analysis of an HIV-positive sub-population in a cohort of patients with invasive Aspergillosis: clinical aspects, use of galactomannan and EORTC criteria validity

Alberto Papaleo*1, Charlotte Martin 2, Stéphane de Wit 2.

Author address: 

1 Hôpitaux Iris Sud; Infectious Diseases; 2 Saint-Pierre University Hospital; Infectious Diseases.

Abstract: 

Background: Invasive aspergillosis (IA) is a deadly infection in HIV positive patients, but it is poorly
reported in literature. Most of the studies were conducted before the introduction of ART and
Galactomannan. Therefore, these parameters are not well studied in this population. In 2008, the
European Organisation for Research and Treatment of Cancer (EORTC) withdrew AIDS from risk
factors for IA, which could make diagnosis even more difficult in this population.
Material/methods: We conducted a retrospective review of 54 cases of IA at Saint Pierre University
Hospital, in Brussels, Belgium, between 2008 and 2014. We compared a sub-population of HIV
infected patients with the rest of cohort to study the clinical aspects, the reliability of Galactomannan
and the validity of EORTC criteria in this population.
Results: We found 15 HIV infected patients in our population, 9 men (60%), median age 49 years old.
HIV infected patients had median CD4 count 64/mm3, median CD4 nadir 40/mm3, median VL 52
copies/ml. The only risk factor in HIV positive population was AIDS in 54% of cases. They were
younger (median age in general population 63 years old), had a more invasive infection (disseminated
24% in HIV positive vs 4% in HIV negative patients) with a greater mortality (73% in HIV positive vs
55% in HIV negative patients). The sensibility of GM in this population was 73% and specificity was
75%.
Conclusions: Despite GM introduction (which seems reliable in this population), the diagnosis of IA in
HIV positive patients is challenging and associated with elevated mortality. Half of our patients didn’t
entirely meet the EORTC criteria for an IA. As a matter of fact, the withdraw of AIDS as risk factor for
IA virtually rules out the diagnosis in this population. These criteria should probably be modified in
order to be used in HIV infected patients.to host cell death.

2017

Poster: 

AttachmentSize
PDF icon EV0127.pdf548.45 KB

abstract No: 

EV0127

Full conference title: 

27th European Congress of Clinical Microbiology and Infectious Diseases (2017, Vienna)
    • ECCMID 27th (2017)