INCIDENCE OF SYMPTOMATIC URINARY-TRACT INFECTIONS IN HIV-SEROPOSITIVEPATIENTS AND THE USE OF COTRIMOXAZOLE AS PROPHYLAXIS AGAINST PNEUMOCYSTIS-CARINII PNEUMONIA

Objectives-To determine the incidence of symptomatic urinary tract inf ections in HIV seropositive patients and to assess whether this varies with stage of disease, risk group or the use of co-trimoxazole as pro phylaxis against Pneumocystis carinii pneumonia. Methods-A retrospecti ve case note review of 175 HIV-infected patients attending The Royal L ondon Hospital between July 1988 and December 1992 was performed. A ur inary tract infection was defined as a pure culture of greater than or equal to 10(5) colony forming units in a mid-stream specimen of urine from a patient with symptoms consistent with a urinary tract infectio n. Results-Urinary tract infections occurred in 10 (5.7%) of 175 patie nts, with an incidence of 1.49 per hundred patient years. Urinary trac t infections were significantly more common in patients with AIDS or a CD4 lymphocyte count below 0.2 x 10(9)/l (or both) when compared to t hose without AIDS and a CD4 lymphocyte count above 0.2 x 10(9)/l (5.4 vs. 0.5 urinary tract infections per hundred patient years, p = 0.0000 5). Women with AIDS or a CD4 count below 0.2 x 10(9)/l (or both) had a n incidence of urinary tract infection of 18.5 per hundred patient yea rs. No significant difference was found between the incidence of urina ry tract infections in those taking co-trimoxazole as Pneumocystis car inii pneumonia prophylaxis and those taking alternative or no prophyla xis (2.6 vs 6.4 per hundred patient years, p = 0.39). Conclusions-Urin ary tract infection represents a considerable health problem amongst H N infected patients. Our data show that urinary tract infections are m ore common in patients with advanced compared with early HIV infection . Co-trimoxazole, when taken by patients as prophylaxis against Pneumo cystis carinii pneumonia did not appear to reduce the incidence of uri nary tract infection.