title: Management of fever in ambulatory HIV-infected adults in resource-limited settings: prospective observational evaluation of a new Mozambican guideline.
abstract: A new Mozambican guideline for management of fever in HIV-infected adults requires malaria testing and systematic consideration of specific alternative diagnoses (eg, tuberculosis and bacterial infections) in addition to malaria. We conducted a prospective observational study of the guideline's performance. Of 258 HIV-infected subjects with axillary temperature ≥37.5° C or history of fever, 76.0% improved, 13.6% died or were hospitalized, and 10.5% were lost to follow-up. In multivariate analyses, factors associated with adverse outcomes were bacterial blood stream infection, syndromically diagnosed tuberculosis, lower CD4 T-lymphocyte count, no antiretroviral therapy, lower body mass index, lower hemoglobin, and nonprescription of antibiotics.
authors.affiliation: *Friends in Global Health, LLC, Maputo, Mozambique; †Vanderbilt Institute for Global Health, Nashville, TN; and ‡Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN.
authors.forename: Paula E
authors.initials: PE
authors.lastname: Brentlinger
authors.forename: Wilson P
authors.initials: WP
authors.lastname: Silva
authors.forename: Manuel
authors.initials: M
authors.lastname: Buene
authors.forename: Luis
authors.initials: L
authors.lastname: Morais
authors.forename: Emilio
authors.initials: E
authors.lastname: Valverde
authors.forename: Sten H
authors.initials: SH
authors.lastname: Vermund
authors.forename: Troy D
authors.initials: TD
authors.lastname: Moon
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy; D000328:Adult; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001424:Bacterial Infections / Q000188:drug therapy / Q000209:etiology; D018791:CD4 Lymphocyte Count; D019468:Disease Management; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic / Q000592:standards*; D011446:Prospective Studies; D012307:Risk Factors; D019562:Viral Load
chemical_list: D000900:Anti-Bacterial Agents; D019380:Anti-HIV Agents