Sepsis in AIDS patients: clinical, etiological, and inflammatory characteristics

Abstract

Intensive care mortality of HIV-positive patients has decreased. However, critically ill HIV-positive patients with sepsis present a worse prognosis. Prospective observational study enrolling patients with severe sepsis/septic shock associated or not with HIV infection, and admitted to ICU. Clinical, microbiological and inflammatory parameters were assessed. The study included 58 patients with severe sepsis/septic shock admitted to ICU, 36 HIV-positive and 22 HIV- negative. All HIV-positive patients met criteria for AIDS. The main foci of infection in HIV-positive patients were pulmonary and abdominal. Fungi and mycobacteria were identified in 44.4% and 16.7% of HIV-positive patients, respectively. In contrast, the main etiologies for sepsis in HIV-negative patients were Gram-negative bacilli (36.4%) and Gram-positive cocci (36.4%). Admition CRP and PCT were lower in HIV-positive patients (130 x 168 mg/dL p= 0.00; 1.19 x 4.06 ng/mL p=0.04, respectively), with a progressive decrease in surviving patients. Initial IL-10 was higher in HIV-positive patients (4.4 pg/mL x 1.0 pg/mL, p=0.005), with moderate accuracy for predicting death (AUC=0.74). In-hospital and 6-month mortality were higher in HIV-positive patients (55.6 x 27.3% p=0.03; 58.3 x 27.3% p=0.02, respectively). Sepsis was more severe in HIV-positive patients. (AU)