期刊
CLINICAL INFECTIOUS DISEASES
卷 52, 期 3, 页码 341-348出版社
UNIV CHICAGO PRESS
DOI: 10.1093/cid/ciq103
关键词
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资金
- United States National Institutes of Health [U01 AI062563]
- AIDS International Training and Research Program [D43 PA-03-018]
- Duke Clinical Trials Unit and Clinical Research Sites [U01 AI069484]
- Duke Center for AIDS Research [P30 AI 64518]
- Center for HIV/AIDS Vaccine Immunology [U01 AI067854]
- Hubert-Yeargan Center for Global Health at Duke University
- Alpha Omega Alpha Carolyn L. Kuckein Student Research Fellowship
Background. Few studies describe patterns of human immunodeficiency virus (HIV) co-infections in African hospitals in the antiretroviral therapy (ART) era. Methods. We enrolled consecutive admitted patients aged >= 13 years with oral temperature of >= 38.0 degrees C during 1 year in Moshi, Tanzania. A standardized clinical history and physical examination was done and hospital outcome recorded. HIV antibody testing, aerobic and mycobacterial blood cultures, and malaria film were performed. HIV-infected patients also received serum cryptococcal antigen testing and CD4(+) T lymphocyte count (CD4 cell count). Results. Of 403 patients enrolled, the median age was 38 years (range, 14-96 years), 217 (53.8%) were female, and 157 (39.0%) were HIV-infected. Of HIV-infected patients, the median CD4 cell count was 98 cells/mu L (range, 1-1,105 cells/mu L), 20 (12.7%) were receiving ART, and 29 (18.5%) were receiving trimethoprimsulfamethoxazole prophylaxis. There were 112 (27.7%) patients who had evidence of invasive disease, including 26 (23.2%) with Salmonella serotype Typhi infection, 24 (21.4%) with Streptococcus pneumoniae infection, 17 (15.2%) with Cryptococcus neoformans infection, 12 (10.7%) with Mycobacterium tuberculosis complex infection, 8 (7.1%) with Plasmodium falciparum infection, and 7 (6.3%) with Escherichia coli infection. HIV infection was associated with M. tuberculosis and C. neoformans bloodstream infection but not with E. coli, S. pneumoniae, or P. falciparum infection. HIV infection appeared to be protective against Salmonella. Typhi bloodstream infection (odds ratio, .12; P = .001). Conclusions. While Salmonella Typhi and S. pneumoniae were the most common causes of invasive infection overall, M. tuberculosis and C. neoformans were the leading causes of bloodstream infection among HIV-infected inpatients in Tanzania in the ART era. We demonstrate a protective effect of HIV against Salmonella. Typhi bloodstream infection in this setting. HIV co-infections continue to account for a large proportion of febrile admissions in Tanzania.
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