PROLONGED FEVER ETIOLOGIES IN HIV/AIDS PATIENTS AND THE RELATION WITH TCD4 COUNT (1/2016 - 6/2019)

Abstract

Objectives: Prolonged fever is a challenge for clinician in managing patients with HIV/AIDS. Their TCD4 counts can be helpful in the diagnosis and treatment. Our goal was to determinethe most common etiologies of prolonged fever and their distribution in different TCD4 count levels in HIV/AIDS patients. 
 Subjects and method: A cross - sectional descriptive study was conducted on 195 HIV/AIDS patients with fever of unknown origin admitted to our hospital from January 2016 to June 2019. We recorded clinical parameters, immune status and etiologies for each patient. Patient immune status based on TCD4 counts was stratified into three levels: < 50 cells/mm3; 50 - 100 cells/mm3 and > 100 cells/mm3. We determined the prolonged fever etiologies in HIV infected patients and compared the distributionof these etiologies in different TCD4 count levels. 
 Results: Among 195 HIV - infected cases with fever of unknown origin, opportunistic infections accounted for 93.3%, non - infectious etiologies took 3.6% and 3.1% were not identified causes. M. tuberculosis was the most common opportunistic infection (46.7%), followed by Talaromycosis (29.2%) and Pneumocytisjiroveci (20.5%), Bacterial pneumonia (11.3%), sepsis (10.3%), CMV (10.3%), Toxoplasma (5.6%), Cryptococcus (2.6%) and MAC (1.0%). Tuberculosis was predominant in all stratified CD4 levels. Most of cases with Talaromycosis had CD4 counts below 50cells/mm3. Besides, CD4 count below 50cells/mm3 was reported in all cases with either Cryptococcus infection or MAC infection. Infections with CMV and toxoplasma were not seen in patients with CD4 count over 100cells/mm3. -7 out of 195 cases were non - infectious etiologies including 4 cases (2.1%) with hemophagocytic lymphohistiocytosis (HLH) syndrome and 3 cases (1.5%) with non - Hodgkin lymphoma. -53.8% of cases were infected by one pathogen while 38% of patients were co - infected by two different pathogens. Co - infection of three pathogens was recognized in 8.2% of study patients.There is no difference between the number of concurrent etiologies and TCD4 levels. 
 Conclusion: Opportunistic infections, especially M. tuberculosis is still the leading cause of prolonged fever in HIV/AIDS patients. T. marnefei should be screened in patients with CD4 < 50cells/mm3. It is important to note that there may be many concurrent etiologies of prolonged fevers in HIV/AIDS patients.