A contemporary investigation of burden and natural history of aspergillosis in people living with HIV/AIDS

Abstract

Background: Untreated HIV infection can lead to profound immunosuppression and increase susceptibility of people living with HIV/AIDS (PLHA) to aspergillosis.Objectives: Reporting the burden and natural history of aspergillosis documented in PLHA admitted in five medical centres in Brazil.Patients and Methods: Clinical, epidemiological and laboratory data were collected in all sequential cases of proven or probable aspergillosis documented in PLHA hospitalised in five medical centres between 2012 and 2020. Results:We enrolled 25 patients ageing between 23 and 58 years (mean = 39) including 11 patients with invasive aspergillosis (IA) and 14 with chronic pulmonary aspergillosis (CPA). The prevalence rate of aspergillosis was 0.1% of 19.616 PLHA. Overall, 72.7% of patients with IA exhibited CD4 < 100 cells/mL and 42.8% of patients with CPA exhibited CD4 count >200 cells/mL. Most patients had a history of tuberculosis, especially those with CPA (85.7%). IA was documented after a mean of 16.5 days of hospitalisation, mainly in critically ill patients exposed to corticosteroids and broadspectrum antibiotics. In the CPA group, a positive culture (71.4%) and radiological alterations were the most frequent findings supporting their diagnosis. Episodes of IA were mostly documented by tissue biopsies. Crude mortality rates were 72.7% and 42.8% in patients with IA and CPA, respectively.Conclusions: Despite being considered an unusual complication in PLHA (0.1%), IA should be considered in patients with profound immunosuppression and pneumonia refractory to conventional therapy. CPA should be investigated in PLHA with chronic deterioration of pulmonary function and previous diagnosis of tuberculosis.

HIV and fungal priority pathogens

“…In Brazil, mortality of 73% was reported in a retrospective review of outcomes of 11 severely immunocompromised people with HIV and invasive aspergillosis. 26 In South Africa, people with HIV admitted to hospital with candidaemia had almost twice the risk of mortality compared with HIV-seronegative patients. 27 …”

Influencing factors and knowledge related to AIDS among high-risk male population in Chongqing

“…Men who have sex with their fellow men (MSM) are at high risk of developing AIDS [1]. Clinical studies have found that in recent years, the incidence of AIDS in high-risk male groups in China has slowly been showing an increasing trend and the proportion of newly diagnosed patients among high risk groups is also increasing every year [2,3]. In addition, men who have sex with their fellow men and are around 20 to 25 years of age, have relatively weak health awareness but have high sexual activities hence, leading to a greater risk of developing AIDS and other diseases due to compromised body immunity [4,5].…”