Analysis of Clinical Characteristics in AIDS Patients Complicated by Pulmonary Aspergillosis

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 shows a higher positive rate in the etiological diagnosis of PA, with Aspergillus fumigatus being the primary pathogen. Treatment with voriconazole is beneficial for improving patients' conditions.