Impact of prophylaxis for Mycobacterium avium complex on bacterial infections in patients with advanced human immunodeficiency virus disease

The epidemiology and natural history of bacterial infections among ambulato ry patients with advanced human immunodeficiency virus (HIV) disease has no t been well described. In this prospective study, 394 subjects were enrolle d and followed at 8-week intervals for a median of 21 months. During follow -up, 164 (42%) of 394 patients developed at least 1 bacterial infection. Th e most common infections were sinusitis, bacterial pneumonia, skin and soft tissue infection, and bronchitis. Serious bacterial infections (defined as bacterial pneumonia, bacteremia, or deep visceral abscess) were reported b y 56 subjects (14%). Female sex, age of <40 years, and Karnofsky score of < less than or equal to>80 were independent risk factors for bacterial infect ions. Prophylaxis with clarithromycin, trimethoprim and sulfamethoxazole, o r both had significant protective effect. The occurrence of any confirmed b acterial infection was associated with a significantly increased risk of mo rtality. This study documents that bacterial infections are common among pa tients with advanced HIV disease, especially among women.