title: Fever of unknown origin in patients with HIV infection in Thailand: an observational study and review of the literature.
abstract: Fever of unknown origin (FUO) is a common presentation for patients with advanced human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS). We prospectively followed 72 patients, consecutively admitted to a Thai regional hospital with FUO and HIV infection to identify aetiologies and mortality in the era of available antiretroviral therapy (ART). Aetiologies of FUO were identified in 67 patients (93%), of whom 61(85%) had an infectious aetiology. The most common infectious aetiologies were Mycobacterium tuberculosis (n=30; 42%), Cryptococcus neoformans (n=17; 24%), Pneumocystis jiroveci (n=9; 13%), Toxoplasma gondii (n=5; 7%), and salmonella bacteraemia (n=5; 7%). Nineteen patients (26%) had co-infection with two or more pathogens. The median CD4 count was 120 cells/mm(3) (range, 1-581 cells/mm(3)), and the all-cause mortality was 22% (n=16). By multivariate analysis, inadequate antimicrobial treatment was the sole predictor of mortality (aOR=4.9; 95% CI=1.2-21.9; P=0.02). Overall, 58 of 72 patients (81%) had an opportunistic infection suggesting that guideline use of ART and prophylactic strategies remain unmet needs that will benefit individuals and populations with HIV/AIDS in Thailand.
authors.affiliation: Division of Internal Medicine, Thammasart University Hospital, Patumthani, Thailand.
authors.forename: Danai
authors.initials: D
authors.lastname: Kitkungvan
authors.forename: Anucha
authors.initials: A
authors.lastname: Apisarnthanarak
authors.forename: Panarat
authors.initials: P
authors.lastname: Plengpart
authors.forename: Linda M
authors.initials: LM
authors.lastname: Mundy
mesh_terms: D000328:Adult; D005260:Female; D005335:Fever of Unknown Origin / Q000188:drug therapy; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013785:Thailand; D016896:Treatment Outcome