Aetiology of prolonged fever in antiretroviral-naïve human immunodeficiency virus-infected adults.
BACKGROUND
Prolonged fever is a common symptom among human immunodeficiency virus (HIV) infected individuals, and is usually due to a cause that is easily treatable. Limited data are available regarding the causes of fever in HIV-infected Indian patients. In this paper, we have profiled the causes of prolonged fever in a cohort of HIV-infected Indian patients and have developed suitable algorithms to assist in an early diagnosis.


METHODS
From February 1997 to October 1998 (20 months), 100 HIV-infected patients (age > 12 years) were evaluated for 100 episodes of prolonged fever (fever > 100 degrees F for more than 2 weeks in outpatients and > 3 days in inpatients). Patients with terminal acquired immunodeficiency syndrome (AIDS) were excluded. Patients were evaluated on the basis of the symptoms associated with prolonged fever and investigated according to pre-existing algorithms.


RESULTS
Among such episodes of fever, infection was the major cause and included tuberculosis, especially the extra-pulmonary and disseminated forms (69%), cryptococcosis (10%) and Pneumocystis carinii pneumonia (7%). Other causes included bacterial pneumonia, amoebic liver abscess, disseminated histoplasmosis and cerebral toxoplasmosis. Patients were naïve for antiretroviral therapy and did not receive prophylaxis for opportunistic infections. The diagnostic yield of ultrasound of the abdomen (85%), fine-needle aspiration cytology of enlarged lymph nodes (75.6%) and bone marrow trephine biopsy (41.6%) were found to be high in our study.


CONCLUSIONS
Tuberculosis is the commonest cause of prolonged fever in HIV-infected adults in India. Non-infectious causes were not seen in this series. We have suggested an algorithmic approach for establishing the cause of fever in these patients. In situations where laboratory evaluation does not reveal a cause for prolonged fever, a therapeutic trial with antituberculous therapy in selected patients is justified.
Rupali
Priscilla
P
Department of General Medicine Unit I and Infectious Diseases, Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India. prisci@cmcvellore.ac.in
Abraham
Ooriapadickal Cherian
OC
Zachariah
Anand
A
Subramanian
Sivaram
S
Mathai
Dilip
D
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis*; D000328:Adult; D000465:Algorithms; D019380:Anti-HIV Agents; D002985:Clinical Protocols; D005260:Female; D005334:Fever / Q000382:microbiology*; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
D019380:Anti-HIV Agents