Aspergillosis is a fungal infection. It can occur in people with healthy or suppressed immune systems. In people with healthy immune systems, it usually causes mild or moderate lung problems. In people with suppressed immune systems, aspergillosis can cause serious lung problems and can also spread to other organs, including the kidneys, liver, skin, bones, and brain. Because these more severe forms of aspergillosis can be life threatening, it is important to diagnose and treat this infection quickly.
Aspergillosis is rare among HIV-positive people, even more so now that combination anti-HIV therapy is available. It is most common among people who have neutropenia – a low level of neutrophils, a type of white blood cell. This type of immune suppression usually isn't seen in people with HIV. It usually occurs in patients being treated for cancer or with powerful immune-suppressing drugs after receiving an organ transplant.
Aspergillosis is caused by Aspergillus, a group of fungi. It is very difficult to avoid these fungi, as they are found throughout the environment. Aspergillus can be found in soil, decomposing plants, household dust, building materials, ornamental plants, food, and water. Dirt, dust, or other materials containing Aspergillus can easily travel through the air and be inhaled into the lungs. People who smoke marijuana, which can contain Aspergillus spores, may be at an increased risk of developing aspergillosis.
What are the symptoms and how is it diagnosed?
The most common symptoms of aspergillosis are pain in this sinuses, nose, or ear canal; facial swelling; cough and difficulty breathing; chest pain; and fever and night sweats.
Because there are many infections that can cause the symptoms associated with aspergillosis, a health care provider will most likely order an x-ray or CT scan to look at the lungs. Aspergillosis usually results in noticeable lesions – called "fungus balls" – in the lungs that can be seen by trained medical experts. From there, it is sometimes necessary to collect fluid or tissue from the lungs in order to confirm the diagnosis.
How is it treated?
A number of treatments have been tested for the treatment of aspergillosis, although not all of these treatments have been studied in patients with AIDS-related aspergillosis.
The preferred treatment for aspergillosis is voriconazole (Vfend), a medication that is administered through an intravenous (IV) line for at least a week. Because of negative drug interactions, voriconazole should be prescribed with caution if protease inhibitors or the non-nucleoside reverse transcriptase inhibitor efavirenz (found in Sustiva, Stocrin and Atripla) is being used to treat HIV.
An alternative to voriconazole is intravenous liposomal amphotericin B (Ambisome, Amphotec or Abelcet). Caspofungin (Cancidas), also administered intravenously, is approved for the treatment of aspergillosis in patients who do not successfully respond to either voriconazole or amphotericin B.
Other alternatives include micafungin (Mycamine), anidulafungin (Eraxis) and posaconazole (Noxafil).
Aspergillosis should be treated until the patient feels better and the CD4 count is above 200 cells.
A syndrome—called immune reconstitution inflammatory syndrome (IRIS)—where antiretroviral treatment can actually exacerbate the symptoms of an opportunistic infection due to a strengthened immune response, has not been reported with Aspergillosis.
Can it be prevented?
There is no guaranteed way to prevent aspergillosis from occurring, given that Aspergillus is found throughout the environment. Aspergillosis is more likely to occur in HIV-positive people with compromised immune systems (less than 100 CD4 cells). Thus, one way to help prevent aspergillosis from occurring is the keep the immune system healthy, such as by using HIV drugs, reducing stress, eating right, and getting plenty of rest.
Last Revised: January 18, 2016