HIV-associated bacteremia: How it has changed in the highly active antiretroviral therapy (HAART) era

To evaluate the changing characteristics of HIV-associated bacteremia in th e highly active antiretroviral therapy (HAART) era, we conducted a prospect ive case control study, comparing two periods of time, before (period A) an d after (period B) the introduction of HAART. In total, 174 patients with b acteremia and 348 controls were studied. By comparing incidence in periods A and B, a statistically significant reduction of bacteremia, from 11.8 to 6.3/100 person-years (PY), was observed (p = .0001). Incidence of hospital- acquired bacteremia decreased from 5.8 episodes/100 PY in period A to 2.4/1 00 PY in period B (p = .0005). A similar trend was also observed for commun ity-acquired episodes of bacteremia, with a value close to statistical sign ificance. Logistic regression analysis indicated that intravenous drug abus e, central venous catheter (CVC) use, high value on APACHE III score, and n eutropenia were independent risk factors for bacteremia in both the study p eriods. Interestingly, comparing the prevalence of bacteremia risk factors in the two study periods, we observed a significant reduction in the use of CVC (p = .04, period A versus period B) and in neutropenia (p = .04). The crude mortality rate was 31% in period A and 23% in period B (p = not signi ficant [ns]). Logistic regression analysis indicated that an high value of Acute Physiology and Chronic Health Evaluation III (APACHE III) score (p < .001) predicted an increased risk of death. Analysis of prognostic factors of bacteremia did not significantly differ in both the study periods. We co nclude that HAART has determined a significant reduction of the incidence a nd a modification of the characteristics of bacteremia. This reduced incide nce may produce a substantial impact on future morbidity and health care co sts of patients with HIV.