Invasive aspergillosis in HIV-positive patients

O. Shadrivova1 , O. Leonova2 , D. Bubnova3 , A. Volkova4 , M. Popova4 , T. Bogomolova5 , S. Ignatyeva5 , L. Zubarovskaya4 , B. Afanasyev4 , N. Vasilyeva5 , N. Klimko1

Author address: 

1Department Of Clinical Mycology, Allergy And Immunology, North-Western State Medical University named after I.I.Mechnikov, St. Petersburg, Russian Federation, 2St. Petersburg Center for the Prevention and Control of AIDS and Infectious Diseases, St. petersburg, Russian Federation, 3North-Western State Medical University named after I.I.Mechnikov, St. Petersburg, Russian Federation, 4 I.Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russian Federation, 5Kashkin Research Institute Of Medical Mycology, North-Western State Medical University named after I.I.Mechnikov, St. Petersburg, Russian Federation

Abstract: 

Objectives: Analysis of underlying diseases, risk factors, etiology, clinical features, treatment and survival rates in HIV-positive patients with IA.

Methods: Retrospective analysis of the register of patients with IAin 1998-2018 yy. For diagnosis IA we used criteria EORTS/MSG, 2008.

Results: In group I we included 12 HIV-positive adult patients with IA from 25 to 52 years old, median – 34,males – 58%. The control group consisted of 545 adult patients withhematological malignancies, from 18 to 78 years old, median - 47, males – 58%. The study of risk factors showed significant differences between these groups. Lymphocytopenia was detected predominantly in HIVpositive patients 75% vs 56%, duration 35 vs 14,5 days, (p = 0.006), while agranulocytosis in this group was observed less frequently – 58% vs 81%, p = 0.008, duration 8 vs 13 days (p = 0.01). Among the HIV+ patients there were no recipients of allogeneic stem cell transplants (0% vs 19%, p = 0.001) and patients receiving immunosuppressive therapy (0% vs 29%, p = 0.02). The main sites of infection were lungs - 100% vs 98%, however hemoptysis and dissemination of infection more often registered in HIV+ patients – 17% vs 6% (p = 0.03)and 17% vs 8% (p = 0.04), respectively.Galactomannan test in BAL was positive in 42% vs 75% cases. Aspergillusspp. were isolated in 42% vs 44%, in all HIV+ patients the main etiological agent of IA was A.fumigatus - 100% vs 45% (p = 0.001). Mixed fungal infection was detected in 33% vs 11% (p = 0,001). «Proven» IA was diagnosed in 17% vs 7% (p = 0.02). Antifungal therapy was used in 100% vs 99% of patients; the most commonly used drug was voriconazole (58% vs 77%). Twelve weeks overall survival rate was 80% vs 81%.

Conclusion: The features of invasive aspergillosisin HIV-positive patientswere:prolonged lymphocytopenia (75%),agranulocytosis was a rare risk factor (58%), more frequent mixed infection - 33%, and high frequency of dissemination of aspergillosis – 17%.The overall 12-week survival did not differ in the studied groups (82% vs 79%).

2019

abstract No: 

P297

Full conference title: 

9th Trends in Medical Mycology Conference 2019
    • TIMM (2019)