MANFREDI R, CHIODO F; Interscience Conference on Antimicrobial Agents and Chemotherapy.

Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 1999 Sep 26-29; 39: 456 (abstract no. 128).

Univ. of Bologna, Bologna, ITALY.

BACKGROUND: A sharp drop in the incidence of most AIDS-related disorders was observed concurrently with the introduction of HAART. Although not included in the list of AIDS-defining events, SB is responsible for appreciable morbidity and mortality during HIV disease, but no data are available regarding the modification of incidence and clinical role of SB in the HAART era.METHODS: The incidence, risk factors, and outcome of HIV-related SB were assessed before and after the introduction of HAART as the standard care of HIV disease. All episodes of SB occurred in HIV-infected patients (p) hospitalized during the years 1994-1995 (pre-HAART period), where compared with those recognized in a p admitted in 1997-1998 (during the HAART era).RESULTS: Of 2,389 p, 332 suffered from SB, leading to an overall mean incidence of 13.9 episodes per 100 p-years. The frequency of SB proved significantly higher during years 1994-1995 compared with 1997-1998 (16.5 vs. 7.9 episodes per 100 p-years: p<.0001). No significant difference was detected as to age, gender, and type of risk for HIV infection, but an advanced (stage C) HIV disease was significantly less frequent among p who developed SB during 1997-1998 compared with the pre-HAART era (p<.05), and concurrent antiretroviral therapy use became significantly more common during recent years (p<.004), together with an increased incidence of gram-negative oxydase-positive bacilli as etiologic agents (p<.05). Among potential risk factors for HIV-related SB, a greater mean CD4+ cell count (p<.002) and a reduced rate of neutropenia (p<.03) were found in p followed during the HAART era, together with a significant increase in the proportion of nosocomially- vs. community-acquired infection (p<.003) (despite a co ncurrent reduction of mean length of hospitalization) (p<.0001). On the other hand, no significant difference was found as to recourse to indwelling catheters, prior administration of cotrimoxazole, broad-spectrum antibiotics and steroids, and disease outcome.CONCLUSIONS: The changing profile of HIV-related morbidity during the HAART era also involves the epidemiological and clinical features of SB: the dramatical 2-fold drop in its incidence observed during recent years seems to be associated with a less advanced HIV disease and a reduced duration of related hospitalization, while an increased rate of nosocomially-acquired infection and hospital-related etiologic agents, were disclosed. The modification of epidemiology and clinical features of SB may act significantly on the management of HIV-infected p in the next years, also influencing health care costs and resource allocation.

Publication Types:

• Meeting Abstracts

Keywords:

• AIDS Vaccines
• Acquired Immunodeficiency Syndrome
• Anti-HIV Agents
• Antimony
• Antiretroviral Therapy, Highly Active
• CD4 Lymphocyte Count
• HIV
• HIV Infections
• HIV Seropositivity
• Hospitalization
• Humans
• Incidence
• Risk Factors

Other ID:

• GWAIDS0008305

UI: 102245802

From Meeting Abstracts