Bacterial Infections in Hiv-Infected Patients

Berger, Barbara J.; Hussain, Fazil; Roistacher, Kenneth

doi:10.1016/s0891-5520(20)30600-0

Cited by 29 publications

(1 citation statement)

References 142 publications

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“…The WHO recommends including pneumococcal conjugate vaccines in childhood immunization programs worldwide [ 35 ], and coverage is high in Mozambique and Brazil. Among adult PLHIV, vaccination has been recommended since the mid-1990s [ 36 ]. However, despite evidence of significant efficacy and immunogenicity of the 7-valent conjugate vaccine among adult PLHIV from Malawi [ 37 ], pneumococcal immunization is not yet available for PLHIV in Africa.…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Tissue Sampling: A Tool to Guide Efforts to Reduce AIDS-Related Mortality in Resource-Limited Settings

Letang

Rakislova

Martínez-Priego

et al. 2021

Clinical Infectious Diseases

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Background Available information on the causes of death among people living with human immunodeficiency virus (PLHIV) in low- and middle-income countries (LMICs) remains scarce. We aimed to provide data on causes of death in PLHIV from two LMICs, Brazil and Mozambique, to assess the impact of clinical misdiagnosis on mortality rates and to evaluate the accuracy of minimally invasive tissue sampling (MITS) in determining the cause of death in PLHIV. Methods We performed coupled MITS and complete autopsy on 164 deceased PLHIV (18 children, 36 maternal deaths, and 110 adults). HIV antibody levels and HIV RNA viral loads were determined from postmortem serum samples. Results Tuberculosis (22.7%), toxoplasmosis (13.9%), bacterial infections (13.9%), and cryptococcosis (10.9%) were the leading causes of death in adults. In maternal deaths, tuberculosis (13.9%), bacterial infections (13.9%), cryptococcosis (11.1%), and cerebral malaria (8.3%) were the most frequent infections, whereas viral infections, particularly cytomegalovirus (38.9%), bacterial infections (27.8%), pneumocystosis (11.1%), and HIV-associated malignant neoplasms (11.1%) were the leading cause among children. Agreement between the MITS and the complete autopsy was 100% in children, 91% in adults, and 78% in maternal deaths. The MITS correctly identified the microorganism causing death in 89% of cases. Conclusions Postmortem studies provide highly granular data on the causes of death in PLHIV. The inaccuracy of clinical diagnosis may play a significant role in the high mortality rates observed among PLHIV in LMICs. MITS might be helpful in monitoring the causes of death in PLHIV and in highlighting the gaps in the management of the infections.

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Section: Discussionmentioning

confidence: 99%

Minimally Invasive Tissue Sampling: A Tool to Guide Efforts to Reduce AIDS-Related Mortality in Resource-Limited Settings

Letang

Rakislova

Martínez-Priego

et al. 2021

Clinical Infectious Diseases

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Infections in HIV-Infected Patients

Ogbuagu

Bruce

2018

Management of Infections in the Immunocompromised Host

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Prognostic Evaluation of Bacteremia and Fungemia in Patients with Acquired Immunodeficiency Syndrome

Torres-Tortosa¹,

Cañueto²,

Bascuñana

et al. 2002

Eur J Clin Microbiol Infect Dis

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The incidence of bacterial infections in general and of bacteremia in particular is high among patients with acquired immunodeficiency syndrome (AIDS). The factors influencing the prognosis of bacteremia in these patients are not well known. In order to better define those factors associated with a poor prognosis, all episodes of bacteremia or fungemia in patients with AIDS who were hospitalized in four general hospitals between 1 September 1987 and 31 December 1996 were studied prospectively. Among 1,390 patients diagnosed with AIDS, 238 (17.1%) developed 274 episodes of bacteremia or fungemia. Mortality related to bacteremia was 21.3%. Variables associated with high mortality were fungemia (odds ratio [OR], 6.19; 95% confidence interval [CI], 1.99 - 19.28), hypotension (OR, 19.65; 95%CI, 7.42 - 52.07), inappropriate antimicrobial treatment (OR, 16.94; 95%CI, 4.92 - 58.32), and unknown origin of bacteremia (OR, 3.93; 95%CI, 1.58 - 9.76). The mortality rate among patients with at least one of these factors was 46.7%, whereas in patients without any of these factors, the rate was 4.9% ( P < 0.001). Bacteremic episodes of unknown origin were significantly more frequently associated with community acquisition ( P = 0.001), inappropriate antimicrobial treatment ( P = 0.04), and etiology by gram-negative microorganisms or fungi ( P < 0.001) and were significantly less frequently associated with the presence of a previous intravenous catheter ( P = 0.004), resulting in peculiar etiologic and epidemiological profiles. The factors that influence the outcome of AIDS patients who develop bacteremia are sometimes avoidable or known during the first days after admission. Therefore, knowledge about these factors could improve the prognosis of bloodstream infections in this population.

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Bacterial Infections in Hiv-Infected Patients

Cited by 29 publications

References 142 publications

Minimally Invasive Tissue Sampling: A Tool to Guide Efforts to Reduce AIDS-Related Mortality in Resource-Limited Settings

Minimally Invasive Tissue Sampling: A Tool to Guide Efforts to Reduce AIDS-Related Mortality in Resource-Limited Settings

Infections in HIV-Infected Patients

Prognostic Evaluation of Bacteremia and Fungemia in Patients with Acquired Immunodeficiency Syndrome

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