Mortality predictive factors of people living with human immunodeficiency virus and bloodstream infection

Introduction: Portugal has one of the highest mortality rates for people living with HIV (PLWHIV) in Eu-rope. After antiretroviral therapy introduction, HIV-associated mortality declined, included the one asso-ciated with bloodstream infection (BSI). However it is still high, and European data are scarce . Therefore, characterizing BSI and defining prognostic factors may improve our approach. Methods: This was a 10-year retrospective study of predictive factors for 30-day and 3-year mortality in PLWHIV with BSI in a tertiary infectious diseases ward. Results: Of 2134 PLWHIV admissions, 145 (6.8%) had a BSI, mostly respiratory and catheter-related bac-teremia and globally community-acquired. Nosocomial infections occurred in 42 (36%) cases, mostly caused by Enterococcus spp, Staphylococcus aureus, and Candida spp. PLWHIV with a BSI had higher 30 -day mortality (27%) compared to those without a BSI (14%). APACHE II score, corticotherapy, and current intravenous drug use (IDU) had a prognostic impact on 30-day mortality. Three-year survival was 54% in PLWHIV with a BSI; a CD4 < 200 cells, vascular or chronic pulmonary disease, and lymphoma were prognostic factors. Conclusions: Patients with a BSI were more likely to present advanced HIV disease, have more comor-bidities, a longer length of stay, and higher 30-day mortality. IDU and severity of infection determined the short-term prognosis. Three-year mortality was primarily influenced by lower CD4 cell counts, hema-tological tumor, and cardiopulmonary comorbidities. Systemic corticotherapy may influence nosocomial BSI and short-term prognosis. (c) 2021 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )

Automated summary

The study found that PLWHIV with BSI had higher 30-day mortality, while three-year survival was influenced by lower CD4 cell counts, hematological tumors, and cardiopulmonary comorbidities.