[Effects induced by the introduction of highly active antiretroviral therapy (HAART) on disseminated bacterial infection during HIV disease].
In order to assess the frequency, risk factors, etiology, and clinical outcome of HIV-related sepsis and bacteremia, according to the introduction of highly active antiretroviral therapy (HAART), all episodes occurred in patients hospitalized during years 1993-1995 (pre-HAART era), have been compared with those diagnosed after HAART introduction (years 1997-2000). On the whole, 498 patients suffered from sepsis/bacteremia in the two considered time periods, but the frequency of this complication proved significantly lower during the last 4 years, as opposed to the pre-HAART period (5.3 versus 18.2 episodes per patient-year: p<.0001). Among potential risk factors, during the last 4 years a significant rise of mean CD4+ lymphocyte count was observed (p<.0001), together with a reduced frequency of neutropenia (absolute neutrophil count <1000 cells/ L) (p<.02), and a less frequent association with an advanced HIV disease (stage C, CDC) (p<.03). Despite a remarkably reduced mean duration of admission, during the HAART era a significant increase of nosocomial- versus community-acquired infection occurred (p<.002), with a related greater frequency of gram-negative bacilli of environmental origin: Pseudomonas, Xanthomonas (Stenotrophomonas), Acinetonbacter spp., and non-fermenting bacilli (p<.05). No significant difference was noticed between the two considered periods, as to patients' age, gender, and type of exposure to HIV, use of central vascular lines, prior administration of steroids, antimicrobials, and cotrimoxazole, as well as disease outcome (including the frequency of related deaths). On the whole, the significant drop of frequency of HIV-associated sepsis/bacteremia occurred after the introduction of HAART (over 3.4-fold, compared with that observed prior to HAART use), proved associated with a reduced degree of immunodeficiency, and a less advanced underlying disease. The proportional increase of nosocomial infections and related pathogens did not match with the apparently significant reduction of mean admission time. A careful and continued monitoring of epidemiological, microbiological, clinical, and treatment features of disseminated bacterial disease looks mandatory even during the HAART era, in order to update therapeutic and prophylactic strategies of HIV disease management.
Manfredi
Roberto
R
Dipartimento di Medicina Clinica Specialistica e Sperimentale, Sezione di Malattie Infettive, Università degli Studi di Bologna, Azienda Ospedaliera di Bologna, Policlinico S Orsola-Malpighi, Bologna, Italy.
Chiodo
Francesco
F
D023241:Antiretroviral Therapy, Highly Active; D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology* / Q000209:etiology*
Effetti indotti dall'introduzione della terapia antiretrovirale ad elevata attivita (HAART) sulle infezioni batteriche disseminate in corso di malattia da HIV.