Nosocomial infections in HIV-infected/AIDS patients

lSeveral pathogenetic processes are involved in the progression to AIDS in HIV-infected individuals. These include a gradual, but ultimately profound, depletion in CD4 lymphocytes, defects in B lymphocytes, neutrophil dysfunc tion and the breakdown of the integument as a consequence of AIDS-related d ermatological conditions such as bacterial and fungal dermatoses and Kaposi 's sarcoma. Each of these factors has important implications regarding host susceptibility to nosocomial infections. This review deals with some of th e difficulties that are encountered in precisely defining the interrelation ships between HIV infection/AIDS and nosocomial sepsis, and some of the con troversies that surround respiratory, bloodstream (including central venous catheter-related infections) and gastrointestinal infections that may be a cquired within healthcare centres. Because of the lack of accurate, detaile d information on this subject, parallels will sometimes be drawn from obser vations made in other immunologically impaired patient groups and from data examining the rates of community-acquired infections in HIV-infected patie nts compared to controls. Appropriate and rational infection practice to mi nimize the risk of acquisition of nosocomial infection is highlighted. Fina lly, some of the common methodological problems commonly encountered in the current: literature regarding nosocomial infections in this population gro up, and future challenges in the study of these infections, are reviewed. ( C) 1999 The Hospital Infection Society.