Relevance of EORTC Criteria for the Diagnosis of Invasive Aspergillosis in HIV-Infected Patients, and Survival Trends Over a 20-Year Period in France.

Abstract

BACKGROUND:

Before the advent of combination antiretroviral therapy (cART), roughly 50% of cases of invasive aspergillosis (IA) associated with human immunodeficiency virus (HIV) infection involved individuals without classical predisposing host factors, and the median survival time was <4 months after diagnosis. We examined if the situation evolved over time using the revised European Organisation for Research and Treatment of Cancer/National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC) definition and analyzed survival trends after diagnosis over 20 years.

METHODS:

A data review committee evaluated 342 medical records that mentioned IA in the French Hospital Database on HIV. Validated cases were classified as fulfilling the EORTC criteria or otherwise as "HIV-related IA." Three periods were analyzed: pre-cART (before 1996), cART era prevoriconazole (1996-2001), and 2002-2011.

RESULTS:

Among 242 validated cases of IA, 124 (51%) fulfilled the EORTC criteria (EORTC-IA) and 118 (49%) were classified as "HIV-related," with similarly low CD4 cell counts in both groups. The proportion of EORTC-IA cases remained stable across the 3 periods (50%, 48%, and 54%, respectively). The 3-month survival rate improved after the advent of cART (38% vs 69%), with no difference between EORTC-IA and HIV-related IA (hazard ratio [HR], 1.2 95% confidence interval [CI] {0.7-1.8}). Voriconazole exposure decreased mortality in 2002-2011 (HR, 0.1 95% CI [0.01-0.8]).

CONCLUSIONS:

In the cART era, EORTC criteria, developed for use in hematology/oncology, still applied to only half the cases diagnosed among HIV-infected patients. A rapid diagnosis of IA is paramount to improve survival. For patients who do not fulfill the EORTC definition, we suggest that the addition of "HIV infected with a CD4 count <100 cells/µL" to the EORTC host criteria be validated.

• Authors: Blandine Denis, Marguerite Guiguet, Nathalie de Castro, Frédéric Mechaï, Matthieu Revest, Giovanna Melica, Dominique Costagliola, Olivier Lortholary, French Hospital Database on HIV National Agency for Research on AIDS and Viral Hepatitis, France CO4
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 61 Issue 8 Pg. 1273-80 (Oct 15 2015) ISSN: 1537-6591 [Electronic] United States
• PMID: 26123932 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: [email protected].

Chemical References

• Anti-HIV Agents
• Antifungal Agents
• Voriconazole

Topics

• Adult
• Anti-HIV Agents (therapeutic use)
• Antifungal Agents (therapeutic use)
• Aspergillosis (complications, diagnosis, drug therapy, epidemiology, mortality)
• Aspergillus (drug effects, pathogenicity)
• CD4 Lymphocyte Count
• Drug Therapy, Combination
• Female
• France (epidemiology)
• HIV Infections (complications, drug therapy)
• Humans
• Invasive Pulmonary Aspergillosis (complications, diagnosis, drug therapy, mortality)
• Male
• Medical Records
• Middle Aged
• Proportional Hazards Models
• Survival Rate
• Time Factors
• Voriconazole (administration & dosage, therapeutic use)