CAUSES OF FEVER IN PATIENTS INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS WHO WERE ADMITTED TO BOSTON-CITY-HOSPITAL

We prospectively studied causes of fever in patients with human immuno deficiency virus (HIV) infection that required admission to a municipa l hospital. A total of 168 HIV-infected persons were admitted for 220 episodes of fever: 72% were male, 80% were nonwhite, 65% reported prio r injection drug use, and 74% had a baseline CD4 lymphocyte count of < 200/mm(3). Bacterial infections, principally pneumonia, accounted for >60% of the episodes; Streptococcus pneumoniae and Staphylococcus aure us were most commonly isolated, Pneumocystis carinii pneumonia (PCP) a nd disseminated infection with Mycobacterium avium complex (MAC) compr ised 53% of the remaining sources of fever, In comparison with episode s of fever due to nonbacterial causes, those associated with common ba cterial infections mere significantly more likely to involve patients with a history of injection drug use (P = .02), higher admission leuko cyte count (P < .004), shorter duration of fever (P = .003), shorter h ospital stays (P = .0001), and a CD4 count of >100/mm(3) (P = .002). W e conclude that bacterial infection, especially pneumonia, is a common cause of fever in HIV-infected patients admitted to our hospital. Pat ients with bacterial infections are more likely to report a history of injection drug use and have CD4 counts of >100/mm(3), shorter duratio n of fever, decreased length of hospitalization, and lower mortality t han patients with fever due to PCP, disseminated MAC infection, or oth er causes.