Causes of Fever in Patients Infected with Human Immunodeficiency Virus Who Were Admitted to Boston City Hospital

• Published in: Clinical infectious diseases 1996-08, Vol.23 (2), p.320-328
• Main Authors: Barat, Lawrence M., Gunn, Julia E., Steger, Kathleen A., Perkins, Chris J., Craven, Donald E.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; AIDS; AIDS-Related Opportunistic Infections - diagnosis; AIDS-Related Opportunistic Infections - etiology; AIDS-Related Opportunistic Infections - physiopathology; AIDS/HIV; Bacterial infections; Bacterial Infections - diagnosis; Bacterial Infections - physiopathology; Bacterial pneumonia; Biological and medical sciences; Blood; Clinical Articles; Female; Fever; Fever - diagnosis; Fever - etiology; Fever - physiopathology; HIV; Hospital admissions; Hospitals; human immunodeficiency virus; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infections; Lymphocytes; Male; Medical sciences; Middle Aged; Mycobacterium avium complex; Outcome Assessment (Health Care); Pneumocystis; Prospective Studies
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/clinids/23.2.320

We prospectively studied causes of fever in patients with human immunodeficiency virus (HIV) infection that required admission to a municipal hospital. A total of 168 HIV-infected persons were admitted for 220 episodes of fever: 72% were male, 80% were nonwhite, 65% reported prior injection drug use, and 74% had a baseline CD4 lymphocyte count of 60% of the episodes; Streptococcus pneumoniae and Staphylococcus aureus were most commonly isolated. Pneumocystis carinii pneumonia (PCP) and disseminated infection with Mycobacterium avium complex (MAC) comprised 53% of the remaining sources of fever. In comparison with episodes of fever due to nonbacterial causes, those associated with common bacterial infections were significantly more likely to involve patients with a history of injection drug use (P = .02), higher admission leukocyte count (P < .004), shorter duration of fever (P = .003), shorter hospital stays (P = .0001), and a CD4 count of >100/mm3 (P = .002). We conclude that bacterial infection, especially pneumonia, is a common cause of fever in HIV-infected patients admitted to our hospital. Patients with bacterial infections are more likely to report a history of injection drug use and have CD4 counts of > 100/mm3, shorter duration of fever, decreased length of hospitalization, and lower mortality than patients with fever due to PCP, disseminated MAC infection, or other causes.