HIV-Associated Bacteremia: How It Has Changed in the Highly Active Antiretroviral Therapy (HAART) Era

Tumbarello, Mario; Tacconelli, Evelina; Donati, Katleen de Gaetano; Citton, Rita; Leone, Fiammetta; Spanu, Teresa; Cauda, Roberto

doi:10.1097/00042560-200002010-00006

Cited by 15 publications

(11 citation statements)

References 17 publications

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“…HAART has also been linked to shorter hospitalization for AIDS patients [23], but in our study, as in others [18], the length of hospitalization for bacteraemia was similar in patients with and without HAART.…”

Section: Discussionsupporting

confidence: 62%

“…The risk factors for bacteraemia identi®ed here were the same for patients with and without HAART, the main factor being severe immunodepression (median CD4 cell counts of 16 and 28/mL, respectively) dramatically more pronounced than the population included in a previous study [18]. These could explain the higher percentage of nosocomial infection and a higher prevalence of P. aeruginosa found in our study.…”

Section: Discussionsupporting

confidence: 55%

“…Tumbarello et al reported similar results for the periods 1994±95 and 1997±98, with incidence rates of, respectively, 11.8 cases of bacteraemia per 100 patient-years (PY) and 6.3/100 PY. However, Tumbarello observed a larger reduction in nosocomial than in community-acquired infections [18]. Patients in whom HAART is ineffective are probably comparable to patients not on HAART who have a low CD4 cell count and remain at risk of hospital-acquired infection.…”

Section: Discussionmentioning

confidence: 97%

“…Effective HAART may even make it possible to discontinue prophylaxis for Pneumocystis carinii, toxoplasmosis and CMV infection in selected cases [15±17]. However, there are few data on the impact of HAART on the occurrence and characteristics of bacteraemia [18,19].…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, it is now possible to discontinue prophylaxis for some opportunistic diseases in patients with immune reconstitution on HAART [15,16,17]. Few studies have focused on the impact of HAART on bacterial infections, and particularly bacteraemia [18,19]. We, therefore, studied the impact of HAART on the occurrence of HIV-associated bacteraemia and their epidemiological and clinical characteristics.…”

Section: Introductionmentioning

confidence: 99%

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Impact of highly active antiretroviral therapy on the occurrence of bacteraemia in HIV‐infected patients and their epidemiologic characteristics

et al. 2003

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Objective 1. to assess the impact of highly active antiretroviral therapy (HAART) on the occurrence of bacteraemia in HIV-infected patients and their clinical and microbiological characteristics. 2. to identify risk factors for bacteraemia in this setting. MethodsThe ®les of all HIV-infected patients hospitalized for an episode of bacteraemia in a 28-bed infectious diseases unit between January 1995 and December 1998 were reviewed. Cases occurring during HAART were compared to cases occurring in patients not receiving HAART. Furthermore, in a case-control study, patients with bacteraemia occurring during HAART were compared with other patients receiving HAART. ResultsThere were 74 episodes of bacteraemia in patients not receiving HAART and 31 episodes in patients receiving HAART. The occurrence of bacteraemia fell from 10.5/100 hospitalizations in 1995 to 5.5/100 in 1998 (P 0.02 trend test). The occurence of P. aeruginosa bacteraemia fell sharply (9/398 vs 1/273, P 0.05). A signi®cant fall in catheter-related infections was observed between 1995 and 1998 (5.5% vs 1.8%). The two-thirds/one-third distribution of hospital-acquired and community-acquired infections remained stable throughout the period study. In patients receiving HAART, the case±control study showed by multivariate analysis, that a CD4 cell count of less than 100/mL [OR 7.3 (1.9±49.7)], and the use of exogenous devices [OR 13.3 (2.5±71)] were signi®cantly associated with the risk of bacteraemia. ConclusionThe introduction of HAART has been associated with a signi®cant fall in the occurrence of bacteraemia. However, patients with a low CD4 cell count remain at risk of bacteraemia with similar microbiological and epidemiological characteristics than in the pre-HAART era.

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Section: Discussionsupporting

confidence: 62%

Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%