Bloodstream infections in patients living with HIV in the modern cART era

L Taramasso,G Cassola,G Cenderello,A Mesini,M Giacomini,A Di Biagio,B Giannini,F Liggieri,C Viscoli,F Bovis

doi:10.1038/s41598-019-41829-3

Abstract

Retrospective multicentre study aiming at analysing the etiology, characteristics and outcome of bloodstream infections (BSI) in people living with HIV (PLWHIV) in an era of modern antiretroviral therapy. Between 2008 and 2015, 79 PLWHIV had at least 1 BSI, for a total of 119 pathogens isolated. Patients were mainly male (72.1%), previous intravenous drug users (55.7%), co-infected with HCV or HBV (58.2%) and in CDC stage C (60.8%). Gram-positive (G+) pathogens caused 44.5% of BSI, followed by Gram-negative (G−), 40.3%, fungi, 10.9%, and mycobacteria, 4.2%. Candida spp. and coagulase-negative staphylococci were the most frequent pathogens found in nosocomial BSI (17% each), while E.coli was prevalent in community-acquired BSI (25%). At the last available follow-up, (mean 3.2 ± 2.7 years) the overall crude mortality was 40.5%. Factors associated with mortality in the final multivariate analysis were older age, (p = 0.02; HR 3.8, 95%CI 1.2–11.7) CDC stage C (p = 0.02; HR 3.3, 95%CI 1.2–9.1), malignancies, (p = 0.004; HR 3.2, 95%CI 1.4–7.0) and end stage liver disease (p = 0.006; HR 3.4, 95%CI 1.4–8.0). In conclusion, the study found high mortality following BSI in PLWHIV. Older age, neoplastic comorbidities, end stage liver disease and advanced HIV stage were the main factors correlated to mortality.

Highlights

Due to the availability of modern combined antiretroviral therapy, patients living with HIV (PLWHIV) have experienced a reduction in overall mortality and incidence of AIDS-defining conditions[1,2]
Despite the fact that the study has been conducted in the context of a modern combined antiretroviral therapy (cART) era, only 66% of the patients were on antiretroviral treatment, and a high number of late presenters (24%) and patients in advanced stage of disease (61% in CDC stage C) were still present in our series
The patients who developed bloodstream infections (BSI) had lower CD4+ counts and higher frequency of late presenters when compared to the global population of PLWHIV without BSI, confirming the importance of immune recovery for preventing bacterial infections other than those commonly codified as AIDS-defining[11]

Summary

Introduction

Due to the availability of modern combined antiretroviral therapy (cART), patients living with HIV (PLWHIV) have experienced a reduction in overall mortality and incidence of AIDS-defining conditions[1,2]. In some countries, including Italy, up to 29% of the patients arrive late at a HIV diagnosis, with CD4+ T-cell (CD4+) count

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Conclusion