Analysis of Clinical Characteristics in AIDS Patients Complicated by Pulmonary Aspergillosis

[ABSTRACT] Objective  To analyze the clinical characteristics of patients with AIDS complicated by pulmonary aspergillosis (PA) and to provide evidence for clinical diagnosis and treatment. Methods A retrospective study was conducted on AIDS patients with PA admitted to the First Hospital of Changsha from July 2021 to February 2025. Clinical data including demographic characteristics, HIV viral load, CD4+ T lymphocyte count, clinical manifestations, imaging features, etiological test results, co-infections, and antifungal treatment were collected. Patients were divided into groups according to clinical types, and differences in clinical characteristics between groups were compared.  Results A total of 29 patients were included, with 22 in the invasive pulmonary aspergillosis (IPA) group and 7 in the chronic pulmonary aspergillosis/allergic bronchopulmonary aspergillosis (CPA/ABPA) group. The most common clinical manifestation and imaging feature were cough (75.9%) and patchy pulmonary shadows (72.4%), respectively. Next-generation sequencing (NGS) showed the highest pathogen detection rate (75.9%), with Aspergillus fumigatus (48.3%) being the predominant pathogen. Twenty-two patients (75.9%) had concurrent fungal infections other than aspergillosis. After PA diagnosis, all patients received antifungal therapy, including 21 (72.4%) treated with voriconazole. Twenty-seven patients (93.1%) showed clinical improvement after treatment. At discharge, 25 patients (86.2%) continued antifungal therapy, of whom 17 (68.0%) received voriconazole. Compared with the CPA/ABPA group, the IPA group had significantly lower rates of antiretroviral therapy (9.1% vs. 57.1%, P < 0.05) and HIV viral suppression (0 vs. 71.4%, P < 0.05), as well as higher proportions of CD4+ T lymphocyte counts < 200 cells/μL (95.5% vs. 28.6%, P < 0.05) and fatigue symptoms (40.9% vs. 14.3%, P < 0.05). No significant differences were observed in other indicators (P > 0.05). Conclusion PA in AIDS patients is predominantly IPA, which mainly occurs in untreated advanced patients with severe immunodeficiency, whereas CPA/ABPA is more common in immunocompetent or mildly compromised patients. NGS demonstrates high diagnostic value for PA, with A. fumigatus being the primary pathogen. Treatment with voriconazole is beneficial for improving patients' conditions.