title: The impact of HIV on presentation and outcome of bacterial sepsis and other causes of acute febrile illness in Gabon.
abstract: OBJECTIVE
  HIV, bacterial sepsis, malaria, and tuberculosis are important causes of disease in Africa. We aimed to determine the impact of HIV on the presentation, causes and outcome of bacterial sepsis and other acute febrile illnesses in Gabon, Central Africa.
  
  
  METHODS
  We performed a prospective observational study in new adult admissions with fever or hypothermia (≥ 38 or <36 °C). Blood cultures, as well as HIV and malaria testing were performed in all patients.
  
  
  RESULTS
  We enrolled 382 patients, including 77 (20.2%) with HIV infection. Malaria was the most frequent diagnosis (n = 130, 34%), and was associated with a more severe presentation in HIV patients. Sepsis was also common (n = 107, 28%), including 29 (7.6%) patients with culture confirmed bacterial bloodstream infection. Bacterial bloodstream infections were more frequent in HIV patients, in particular with S. pneumoniae. Tuberculosis was observed in 29 (7.6%) patients, and was also more common in HIV patients. The majority of HIV patients was newly diagnosed, and only 15 (19.5%) were using combination antiretroviral therapy.
  
  
  CONCLUSIONS
  Our findings illustrate the impact of HIV co-infection on the burden of sepsis, malaria and tuberculosis in Gabon, as well as the need to scale up HIV counseling, testing and treatment.
authors.affiliation: Division of Infectious Diseases, Center of Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Room G2-105, 1105 AZ, Amsterdam, The Netherlands, m.a.huson@amc.uva.nl.
authors.forename: Michaëla A M
authors.initials: MA
authors.lastname: Huson
authors.forename: Rachel
authors.initials: R
authors.lastname: Kalkman
authors.forename: Sebastiaan M
authors.initials: SM
authors.lastname: Stolp
authors.forename: Saskia
authors.initials: S
authors.lastname: Janssen
authors.forename: Abraham S
authors.initials: AS
authors.lastname: Alabi
authors.forename: Justin O
authors.initials: JO
authors.lastname: Beyeme
authors.forename: Tom
authors.initials: T
authors.lastname: van der Poll
authors.forename: Martin P
authors.initials: MP
authors.lastname: Grobusch
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D000328:Adult; D060085:Coinfection / Q000453:epidemiology*; D005260:Female; D005334:Fever / Q000453:epidemiology; D005681:Gabon / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008288:Malaria / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*