Fever of unknown origin in HIV-infected patients: a critical analysis of a retrospective series of 57 cases.
OBJECTIVE
The aim of the study was to assess the incidence and aetiology of fever of unknown origin in human immunodeficiency virus (HIV)-infected patients, and to evaluate the usefulness of the main diagnostic procedures.


METHODS
A retrospective study.


METHODS
We reviewed the records of 270 HIV-infected patients who were hospitalized for the first time in a department of infectious and tropical diseases during the 27 month study period.


METHODS
Fifty-seven patients (21%) had a history of fever of unknown origin.


RESULTS
The aetiology was found in 49 cases (86%). The major cause of the fever was mycobacteriosis: atypical mycobacteria in 10 cases, Mycobacterium tuberculosis in 10, mycobacteria of unspecified type in two, and BCG strain in one. A liver biopsy and a thoracic CT scan greatly contributed to the diagnosis of mycobacterial infection. Seventeen patients were given empiric antimycobacterial therapy as a therapeutic test, of whom seven had a favourable response. The other main causes of fever were cytomegalovirus infection in five patients, leishmaniasis in four, and lymphoma in four.


CONCLUSIONS
Fever of unknown origin is a frequent occurrence in the course of HIV infection, and mycobacterial infection should be considered as a first-line diagnosis in such cases. The place of empiric antimycobacterial therapy in the diagnostic strategy requires further evaluation, but appears to be an alternative to multiple investigative procedures.
Bissuel
F
F
Department of Infectious and Tropical Diseases, Bichat-Claude Bernard Hospital, Paris, France.
Leport
C
C
Perronne
C
C
Longuet
P
P
Vilde
J L
JL
D000328:Adult; D003937:Diagnosis, Differential; D005335:Fever of Unknown Origin / Q000209:etiology* / Q000382:microbiology; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007239:Infections / Q000150:complications / Q000175:diagnosis*; D008223:Lymphoma / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies