EVOLUTION OF FEVER IN PATIENTS INFECTED W ITH HIV TREATED FOR TUBERCULOSIS

Objectives. To compare the fever course after starting therapy in pati ents diagnosed of active tuberculosis with and without HIV infection a nd evaluate the usefulness of empiric antituberculous therapy in diagn osing the disease. Methods. Review of clinical records from all patien ts meeting the following criteria for three years: recovery of Mycobac terium tuberculosis from any clinical sample, knowledge of serological status to HIV, initial therapy of tuberculosis, absence of ther cause s of fever identified, and not being treated with drugs which potentia lly could interfere with the course of fever during their hospital sta y. Results. At admission HIV-positive patients with tuberculosis were afebrile in a significantly lower proportion than HIV-negative patient s (17% vs. 54%, respectively; p<0.001). After initiating antituberculo us therapy, the median time to fever resolution was similar in both HI V-positive and HIV-negative patients (6 and 4 days, respectively). Aft er two weeks of therapy, 25% of HIV-positive patients and 23% HIV-nega tive patients still had fever. No factor was identified which could pr edict the delay in resolution of fever. Conclusions. The course of fev er was similar in both HIV-positive and HIV-negative patients after in itiating antituberculous therapy. This empirical therapy may be useful in diagnosing tuberculosis, as fever resolved in the first two weeks of therapy in most patients.