Immune reconstitution in AIDS: oncologic implications and hematologic approaches

Invasive pulmonary aspergillosis transformed into fatal mucous impaction by immune reconstitution in an AIDS patient

Reported here is the case of a newly diagnosed AIDS patient with end-stage HIV infection and biopsy-proven invasive pulmonary aspergillosis who responded to antifungal therapy but developed severe mucous impaction in association with rapid immune restoration that was ultimately fatal. Invasive pulmonary aspergillosis complicates about 4% of AIDS infections. A search of the medical literature revealed no previous report of this organism's involvement in immune restoration syndrome.

[Effect of highly active antiretroviral therapy on the clinical onset of AIDS defined by clinical episodes]

BACKGROUND

The frequency of opportunistic infections and the mortality of HIV-infected patients have changed notably since the widespread use of highly active antiretroviral therapy. Accordingly, the spectrum of first AIDS-defining conditions may have changed too. The aim of the present study was to analyze whether there have been changes in the clinical presentation of AIDS after the extensive use of highly active antiretroviral therapy.

PATIENTS AND METHOD

We performed an analysis of the presentation forms of AIDS in 190 patients with a prospective follow-up who developed this disease between April 1989 and December 2000. We compared the first AIDS-defining conditions occurring until December 1996 with those occurring after January 1997.

RESULTS

Visceral leishmaniasis was the first AIDS-defining condition in 18 patients (14.2%) during the first period, whereas it was the AIDS-onset disease in two cases (3.1%) during the second period (P = 0.01). Tuberculosis was the first diagnosis in 63 patients (50%) in the first period and in 26 cases (40.6%) in the second period (P = 0.22). The frequency of other first AIDS-defining disorders remained unchanged along the whole study time.

CONCLUSION

With regard to the clinical onset of AIDS, there has been a significant reduction in the frequency of visceral leishmaniasis as the first AIDS-defining disorder after the introduction of highly active antiretroviral therapy. Tuberculosis continues to be the more frequent clinical debut condition of AIDS.