Invasive aspergillosis in patients with HIV infection: report of two patients and a review of the literature

Because patients who are infected with the human immunodeficiency virus (HIV) have defective immune systems, so-called opportunistic infections often develop. Infection with the fungus Aspergillus (aspergillosis) can occur when the ability of neutrophils and macrophages, cells of the immune system, to destroy or engulf invading organisms (phagocytosis) becomes impaired. Phagocytosis in patients with AIDS is defective. However, aspergillosis is not common in patients with AIDS. Between May 1983 and June 1984, 3,170 cases of AIDS were reported to the Centers for Disease Control, with only five of these cases involving aspergillosis (0.16 percent). Two case studies of patients with AIDS who had invasive aspergillosis are reported, and other cases described in the literature are reviewed. Infection with aspergillus is serious and survival rates are very low, even with antifungal therapy and surgical resection. Risk factors for the development of aspergillosis include low numbers of neutrophils, treatment with corticosteroids, and prior underlying lung disease. AIDS patients who receive drugs that adversely affect neutrophils, and those who have underlying lung disease (usually pneumonia caused by Pneumocystis carinii), must be aware of the possibility of the development of the serious, and often fatal aspergillosis. (Consumer Summary produced by Reliance Medical Information, Inc.)