Infections with various species of the fungus Aspergillsus are increasingly observed in patients with late stage HIV disease, especially those that have developed neutropenia from underlying HIV infection or myelosuppressive medication. The organism is ubiquitous, being found in soil and water and enters the body through the lungs. The fungal hyphae germinate in the alveoli and invade pulmonary tissue and blood vessels, leading to tissue necrosis and dissemination. Infection has been reported in the brain, heart, liver, spleen, kidneys, pancreas, sinuses and skin.

Diagnosis is by culture and histopathology. Culture positivity alone may reflect environmental contamination; fewer than 10% of patients with positive sputum cultures may have invasive disease, although among neutropenic patients this rises to 23%.

Aspergillosis responds best to treatment when it is diagnosed early and treated aggressively. Intravenous amphotericin B is generally used as induction therapy and itraconazole as maintenance or in patients unable to tolerate amphotericin. The bioavailability of itraconazole should be improved by ensuring that it is taken with food or the liquid formulation is used.