The impact of HIV on presentation and outcome of bacterial sepsis and other causes of acute febrile illness in Gabon.

PURPOSE: 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.

Community-acquired bacterial bloodstream infections in HIV-infected patients: a systematic review.

Information on community-acquired bacterial bloodstream infections (BSIs) in individuals infected with human immunodeficiency virus (HIV) is limited. We conducted a systematic literature review. The case fraction of community-acquired bacterial BSIs in hospitalized patients is 20% and 30% in adults and children, respectively, compared to 9% in HIV-negative adults and children. Worldwide, the main pathogens of community-acquired BSI are nontyphoid salmonellae (NTS), Streptococcus pneumoniae, Escherichia coli, and Staphylococcus aureus, but regional differences are apparent, especially for S. pneumoniae. Compared to HIV-negative populations, HIV patients are particularly at risk to develop NTS bacteremia. Bacteremia incidence is related to immunosuppression, and antiretroviral therapy reduces the incidence of BSI in HIV patients (rate ratios, 0.63-0.02). Mortality rates varied between 7% and 46%. These results suggest that bacterial BSI is more likely to be found in HIV-positive than in HIV-negative patients upon hospitalization, and that causative pathogens vary by region.