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


METHODS
The files 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.


RESULTS
There 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 significant 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/ micro L [OR = 7.3 (1.9-49.7)], and the use of exogenous devices [OR = 13.3 (2.5-71)] were significantly associated with the risk of bacteraemia.


CONCLUSIONS
The introduction of HAART has been associated with a significant 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.
Meynard
J-L
JL
Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, Inserm U 444, Faculté de Médecine Saint-Antoine, and Laboratoire de Bactériologie, Hôpital Saint-Antoine, Paris, France. jean-luc.meynard@sat.ap-hop-paris.fr
Guiguet
M
M
Fonquernie
L
L
Lefebvre
B
B
Lalande
V
V
Honore
I
I
Meyohas
M-C
MC
Girard
P-M
PM
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D016470:Bacteremia / Q000175:diagnosis*; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003428:Cross Infection; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000382:microbiology*; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination