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  • Relevance of EORTC Criteria...
    Denis, Blandine; Guiguet, Marguerite; de Castro, Nathalie; Mechaï, Frédéric; Revest, Matthieu; Melica, Giovanna; Costagliola, Dominique; Lortholary, Olivier

    Clinical infectious diseases, 10/2015, Letnik: 61, Številka: 8
    Journal Article

    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.