Asymptomatic bacteriuria in human immunodeficiency (HIV)-infected women

Abstract

Objective: To determine the prevalence of bacteriuria in HIV- infected women versus healthy non-HIV-infected controls. Methods: A prospective cohort study was undertaken between January 1996 and March 1997. One hundred nineteen ambulatory, premenopausal women from the Women’s HIV Clinic and 191 similar non-infected Gynecology Clinic controls were recruited. Information recorded from the medical record and patient questionnaire included: age, prior history of UTI, antibiotic usage, sexual frequency, diaphragm/spermicide use, and CD4 count. A clean catch urine culture was collected on all patients. Statistical analysis was via SPSSPC. Results: The mean age of HIV-infected women was 33 vs 26 for non-infected. The mean CD4 count was 341. A prior history of UTI (mean # per lifetime) was significantly higher for HIV women (2.8) vs controls (1.8) [ P = .01]. The mean weekly sexual frequency was significantly higher in HIV-negative (2.1) vs HIV-infected (1.2) [ P < .001]. Diaphragm/spermicidal use was uncommon but equal in both groups. The prevalence of any growth of uropathogens (>10 2 cfu/mL) was 30% in the HIV-infected vs 47% in controls. The percentage of asymptomatic bacteriuria for each range of uropathogen titer (cfu/mL) in urine was: (cfu/mL) HIV ( n = 119) Non-HIV ( N = 191) No Growth 70% 53% 10 2–10 3 13% 17% 10 3–10 4 11% 53% 10 4–10 5 1% 4% >10 5 5% 6% Chronic antibiotic usage (39% of HIV-infected vs 4% of controls) was associated with a decreased prevalence of bacteriuria, but there was not a significant difference in prevalence of bacteriuria between groups. Regardless of titer ranges of uropathogens evaluated, the prevalence of bacteriuria was not different between CD4 counts of <200 and ≥200. As compared to controls, HIV-infected individuals demonstrated shifts toward nosocomial pathogens: Enterococcus, S. aureus and non- E. coli gram-negative rods. Conclusion: The prevalence of bacteriuria was not greater in HIV-infected women versus non-HIV-infected women versus HIV non-infected controls and was not significantly affected by antibiotic usage or CD4 count. Uropathogens responsible for asymptomatic bacteriuria in HIV-infected women are different from “healthy” controls and are more representative of nosocomial flora.