FEVER OF UNKNOWN ORIGIN IN HIV-INFECTED PATIENTS - A CRITICAL ANALYSIS OF A RETROSPECTIVE SERIES OF 57 CASES

Objectives. The aim of the study was to assess the incidence and aetio logy of fever of unknown origin in human immunodeficiency virus (HIV)- infected patients, and to evaluate the usefulness of the main diagnost ic procedures. Design. A retrospective study. Setting and subjects. We reviewed the records of 270 HIV-infected patients who were hospitaliz ed for the first time in a department of infectious and tropical disea ses during the 27 month study period. Main outcome measures. Fifty-sev en patients (21%) had a history of fever of unknown origin. Results. T he aetiology was found in 49 cases (86%). The major cause of the fever was mycobacteriosis: atypical mycobacteria in 10 cases, Mycobacterium tuberculosis in 10, mycobacteria of unspecified type in two, and BCG strain in one. A liver biopsy and a thoracic CT scan greatly contribut ed to the diagnosis of mycobacterial infection. Seventeen patients wer e given empiric antimycobacterial therapy as a therapeutic test, of wh om seven had a favourable response. The other main causes of fever wer e cytomegalovirus infection in five patients, leishmaniasis in four, a nd lymphoma in four. Conclusions. Fever of unknown origin is a frequen t occurrence in the course of HIV infection, and mycobacterial infecti on should be considered as a first-line diagnosis in such cases. The p lace of empiric antimycobacterial therapy in the diagnostic strategy r equires further evaluation, but appears to be an alternative to multip le investigative procedures.