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

Abstract

To evaluate the changing characteristics of HIV-associated bacteremia in the highly active antiretroviral therapy (HAART) era, we conducted a prospective case control study, comparing two periods of time, before (period A) and after (period B) the introduction of HAART. In total, 174 patients with bacteremia and 348 controls were studied. By comparing incidence in periods A and B, a statistically significant reduction of bacteremia, from 11.8 to 6.3/100 person-years (PY), was observed (p = .0001). Incidence of hospital-acquired bacteremia decreased from 5.8 episodes/100 PY in period A to 2.4/100 PY in period B (p = .0005). A similar trend was also observed for community-acquired episodes of bacteremia, with a value close to statistical significance. Logistic regression analysis indicated that intravenous drug abuse, central venous catheter (CVC) use, high value on APACHE III score, and neutropenia were independent risk factors for bacteremia in both the study periods. Interestingly, comparing the prevalence of bacteremia risk factors in the two study periods, we observed a significant reduction in the use of CVC (p = .04, period A versus period B) and in neutropenia (p = .04). The crude mortality rate was 31% in period A and 23% in period B (p = not significant [ns]). Logistic regression analysis indicated that an high value of Acute Physiology and Chronic Health Evaluation III (APACHE III) score (p < .001) predicted an increased risk of death. Analysis of prognostic factors of bacteremia did not significantly differ in both the study periods. We conclude that HAART has determined a significant reduction of the incidence and a modification of the characteristics of bacteremia. This reduced incidence may produce a substantial impact on future morbidity and health care costs of patients with HIV.

Incidence of and risk factors for bacteraemia in HIV-infected adults in the era of highly active antiretroviral therapy

“…The organism-specific bacteraemia rates reported in this study are consistent with previous findings in the literature that support the predominance of S. aureus, coagulasenegative staphylococci and S. pneumoniae as pathogens in bacteraemia among HIV-infected patients in developed countries [2,8,[15][16][17][18][19]. This contrasts with studies conducted in the developing world, particularly in Africa and Southeast Asia, which document higher rates of Salmonella species bacteraemia [3,20].…”

“…Several modifiable factors appear to be protective against development of bacteraemia, including use of HAART, high CD4 cell count and not using injection drugs. hospitalizations, both in 1998 [5,8]. While our estimates are lower, these studies were both restricted to hospitalized patients at one clinic site in Europe during the early HAART era, and may not be applicable to HIV-infected patients living in the USA in the current HAART era.…”

“…bacteraemic episodes in the pre-and early highly active antiretroviral therapy (HAART) periods [2,7,8]. In recent years, methicillin-resistant Staphylococcus aureus (MRSA) infection has emerged as a significant complication among HIV-infected subjects [10][11][12][13][14].…”

“…In one study, the incidence of bacteraemia dropped from 118/1000 person-years (PY) in 1994-1995 to 63/1000 PY in 1997-1998 among hospitalized patients [8]; another study reported a drop in bacteraemia incidence from 105/1000 hospitalizations in 1995 to 55/1000 hospitalizations in 1998 [5]. In contrast, the incidence of MRSA bacteraemia increased from 5.3/1000 PY in 2000-2001 to 11.9/1000 PY in [2003][2004] in one site [12].…”

Major but differential decline in the incidence of Staphylococcus aureus bacteraemia in HIV‐infected individuals from 1995 to 2007: a nationwide cohort study*

“…Over the last decade, the degree of immune deficiency in HIV-infected individuals has diminished as a result of increased coverage of HAART [25]. The incidence of bacterial BSIs has similarly decreased [26,27]. In our study, lack of HAART was associated with a 2-fold increased risk of SAB and, correspondingly, individuals who were virologically nonsuppressed were at an increased risk.…”