title: Sepsis in AIDS patients: clinical, etiological and inflammatory characteristics.
abstract: BACKGROUND
  Intensive care mortality of HIV-positive patients has progressively decreased. However, critically ill HIV-positive patients with sepsis present a worse prognosis. To better understand this condition, we propose a study comparing clinical, etiological and inflammatory data, and the hospital course of HIV-positive and HIV-negative patients with severe sepsis or septic shock.
  
  
  METHODS
  A prospective observational study enrolling patients with severe sepsis or septic shock associated or not with HIV infection, and admitted to intensive care unit (ICU). Clinical, microbiological and inflammatory parameters were assessed, including C-reactive protein (CRP), procalcitonin (PCT), interleukin-6, interleukin-10 and TNF-α. Outcome measures were in-hospital and six-month mortality.
  
  
  RESULTS
  The study included 58 patients with severe sepsis/septic shock admitted to ICU, 36 HIV-positive and 22 HIV-negative. All HIV-positive patients met the criteria for AIDS (CDC/2008). The main foci of infection in HIV-positive patients were pulmonary and abdominal (p=0.001). Fungi and mycobacteria were identified in 44.4% and 16.7% of HIV-positive patients, respectively. In contrast, the main etiologies for sepsis in HIV-negative patients were Gram-negative bacilli (36.4%) and Gram-positive cocci (36.4%) (p=0.001). CRP and PCT admission concentrations were lower in HIV-positive patients (130 vs. 168 mg/dL p=0.005, and 1.19 vs. 4.06 ng/mL p=0.04, respectively), with a progressive decrease in surviving patients. Initial IL-10 concentrations were higher in HIV-positive patients (4.4 pg/mL vs. 1.0 pg/mL, p=0.005), with moderate accuracy for predicting death (area under receiver-operating characteristic curve =0.74). In-hospital and six-month mortality were higher in HIV-positive patients (55.6 vs. 27.3% p=0.03, and 58.3 vs. 27.3% p=0.02, respectively).
  
  
  CONCLUSIONS
  The course of sepsis was more severe in HIV-positive patients, with distinct clinical, etiological and inflammatory characteristics.
authors: Department of Infectious and Parasitic Diseases, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors: João Manoel
authors: JM
authors: Silva
authors: Sigrid De Sousa
authors: Sde S
authors: dos Santos
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D016470:Bacteremia / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D016207:Cytokines / Q000097:blood; D016469:Fungemia / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality / Q000473:pathology*; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: C000606589:CALCA protein, human; D016207:Cytokines; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide
keywords: AIDS; HIV; etiology; inflammatory markers; mortality; sepsis
references: Eur Respir J. 2005 Apr;25(4):688-92
references: 15802344
references: Behav Res Methods. 2009 Feb;41(1):47-54
references: 19182123
references: Br J Haematol. 2001 Oct;115(1):53-7
references: 11722409
references: Int J Pancreatol. 2000 Aug;28(1):41-9
references: 11185709
references: MMWR Recomm Rep. 2009 Apr 10;58(RR-4):1-207; quiz CE1-4
references: 19357635
references: N Engl J Med. 2006 Jul 13;355(2):173-81
references: 16837681
references: Eur J Cardiothorac Surg. 1998 May;13(5):541-5
references: 9663535
references: Crit Care Med. 1992 Jun;20(6):724-6
references: 1597021
references: J Infect Dis. 2006 Jan 15;193(2):251-8
references: 16362889
references: Tohoku J Exp Med. 2008 Sep;216(1):61-8
references: 18719339
references: Crit Care. 2005;9(6):R623-30
references: 16280060
references: Prev Vet Med. 2000 May 30;45(1-2):23-41
references: 10802332
references: Support Care Cancer. 2005 May;13(5):343-6
references: 15657690
references: J Gerontol A Biol Sci Med Sci. 2010 Mar;65(3):266-73
references: 19808837
references: Curr Opin Infect Dis. 2012 Jun;25(3):328-36
references: 22421751
references: J Infect Dis. 1995 Jan;171(1):225-8
references: 7798669
references: J Infect. 1997 Jul;35(1):41-6
references: 9279723
references: Curr Mol Med. 2010 Nov;10(8):727-40
references: 20937022
references: Clin Exp Immunol. 1999 Apr;116(1):115-20
references: 10209514
references: Crit Care Med. 2000 Apr;28(4):1226-8
references: 10809314
references: Immunol Rev. 2008 Dec;226:205-18
references: 19161426
references: Crit Care Med. 2000 Jun;28(6):1828-32
references: 10890628
references: Crit Care Med. 2001 Jul;29(7):1303-10
references: 11445675
references: Crit Care Med. 2004 Nov;32(11 Suppl):S578-90
references: 15542967
references: Crit Care. 2011 Aug 08;15(4):180
references: 21888682
references: Lancet Infect Dis. 2006 Dec;6(12):794-804
references: 17123899
references: Dan Med Bull. 2008 Nov;55(4):219-23
references: 19232162
references: Kansenshogaku Zasshi. 1999 Mar;73(3):197-204
references: 10222664
references: Intensive Care Med. 2006 Sep;32(9):1344-51
references: 16799774
references: J Intensive Care Med. 2007 Mar-Apr;22(2):73-81
references: 17456727
references: Chest. 2009 Jan;135(1):11-17
references: 18719058
references: J Clin Endocrinol Metab. 2004 Apr;89(4):1512-25
references: 15070906
references: Crit Care Med. 2006 Jan;34(1):42-9
references: 16374154
references: Clin Infect Dis. 2005 Nov 15;41 Suppl 7:S481-9
references: 16237651
references: Crit Care Med. 2009 May;37(5):1605-11
references: 19325488
references: Chest. 2006 Jun;129(6):1432-40
references: 16778259
references: Crit Care Med. 1985 Oct;13(10):818-29
references: 3928249
references: Infection. 1996 Nov-Dec;24(6):434-6
references: 9007590
references: Crit Care Med. 1999 Jul;27(7):1262-4
references: 10446817
references: BMC Infect Dis. 2007 Nov 22;7:137
references: 18034890
references: J Infect Dis. 1995 Jan;171(1):229-32
references: 7798670
references: AIDS. 2004 Jul 2;18(10):1429-33
references: 15199319
references: Clin Chem Lab Med. 1999 Mar;37(3):363-8
references: 10353484
references: Am J Respir Crit Care Med. 2001 Aug 1;164(3):396-402
references: 11500339
references: Cardiovasc Surg. 2000 Dec;8(7):550-4
references: 11068216
references: Crit Care Med. 1998 Nov;26(11):1793-800
references: 9824069
references: Crit Care Med. 2010 Feb;38(2):367-74
references: 20035219
references: Am J Infect Control. 2008 Jun;36(5):309-32
references: 18538699
references: Comput Methods Programs Biomed. 1995 Dec;48(3):257-62
references: 8925653
references: J Antimicrob Chemother. 2011 Apr;66 Suppl 2:ii33-40
references: 21398306
references: Crit Care. 2011 Aug 26;15(4):R202
references: 21871086
references: Eur Respir J. 2003 Jun;21(6):939-43
references: 12797485
references: Crit Care. 2010;14(4):R152
references: 20698966
references: Crit Care Med. 2002 Mar;30(3):529-35
references: 11990910