Role of antiretroviral therapy in long-term survival of patients with AIDS-related pulmonary aspergillosis

The aim of the study presented here was to describe the clinical presentation and outcome of invasive pulmonary aspergillosis (IPA) in a cohort of HIV-infected patients and to assess factors associated with survival by means of a longitudinal study of all HIV-infected adults with IPA who attended the infectious diseases service of a tertiary center between January 1985 and December 1998. The outcome measure was the time to death after diagnosis of IPA. The endpoint for data collection and survival analysis was 31 December 1998. Nineteen of 1605 HIV-infected patients were identified, resulting in an overall IPA attack rate of 1.12%. Most patients had AIDS (95%). Unilateral cavitary disease was the most frequent radiographic presentation (37%). Median survival was 148 days (95% confidence interval [95% CI], 0-402), but it exceeded 12 months in 37%. In patients in whom antiretroviral treatment (ART) was initiated or modified in relation to the IPA diagnosis, median survival increased to 906 days (95% CI, 754-1058; 1-year survival, 83%) compared with 86 days in those who did not take any ART (95% CI, 55-117; 1-year survival, 8%; P = 0.0002). Survival was even longer when ART changes included only nucleoside reverse transcriptase inhibitors, prior to the availability of protease inhibitors (833 days, 95% CI, 369-1297; 1-year survival 75%; P = 0.003). Three (16%) patients are still alive after a mean time of 36 months postdiagnosis. Although IPA is a life-threatening complication of advanced AIDS, it does not always lead to short-term death. An adequate management of HIV infection together with antifungal treatment may prolong survival and, as described for other AIDS-related disorders, a significant decrease in its occurrence can be expected.