AIDS-defining fungal opportunism in the HAART era. Trend of frequency and reduced incidence when HIV protease inhibitors are administered

Abstract number: p1226

Manfredi  R., Calza  L., Chiodo  F.

Background: 

Nine years after the introduction of HAART, opportunistic AIDS-related mycoses show a progressive drop of incidence. Aim of our work is to assess the temporal trend of major AIDS-associated fungal infections during the last three-year period, and to relate our figures with HAART administration, and the different combinations of administered antiretrovirals, with attention focused on protease inhibitors (PI).

Methods: 

Through a retrospective analysis of clinical-microbiological records, 118 episodes of AIDS-defining mycoses were identified from 2001 to June 30, 2005.

Results: 

The great majority of the 118 episodes of visceral mycosis was represented by esophageal candidiasis (101 cases), followed by CNS-disseminated cryptococcosis (15 episodes), and candidemia (two episodes). The temporal trend demonstrated a progressive tendency to a reduction of diagnosed cases: 34 in the year 2001, 27 in the year 2002, 25 in the year 2003, 12 in the year 2004, and 20 in the first 6 months of 2005. In even 63 patients (p) of 118 (53.4%), visceral mycoses occurred concomitantly with the first positive HIV serodiagnosis: the so-called "AIDS presenters", who were never treated with antiretrovirals. In the remaining 55 episodes, fungal infections occured as the first AIDS-related disorder in 31 cases, while in 24 p they represented a subsequent opportunistic complication interesting p already diagnosed with AIDS. Although all p suffered from an advanced HIV disease (as expressed by a CD4+ lymphocyte count of 127.3 ± 52.7 cells/mL), among the 55 patients who were taking antiretrovirals, PI were administered in 11 p only, while other combinations excluding PI were used in 44 p (p < 0.001).

Conclusions: 

Over 50% of episodes of visceral candidosis and cryptococcosis occur in "AIDS presenters", while the lack of adjunct of PI could contribute to explain the apparent increased predisposition to these opportunism versus other AIDS-defining diseases. Pathogenetic hypotheses cannot exclude the demonstrated direct in vitro antifungal effect exerted by PI.