[Left-sided endocarditis in patients with HIV infection]

Left-sided endocarditis in HIV-infected patients has an special clinical, epidemiological and microbiological characteristics and its relationship with drug addicts subjects is unknown.

Since 1986 up to 1996 we have been diagnosed 214 episodes of infective endocarditis in 190 HIV-infected patients. In 34 cases (15%) there was left-sided endocarditis. These patients are described.

Mean age was 30 years and 28 were male (82%). Thirty patients had been intravenous drug addicts (IVDA) but only 18 were active-IVDA. In three cases the endocarditis was nosocomial. Mean CD4+ lymphocyte count was 176 per mm3 and 59% were AIDS-patients. Tuberculosis was the most frequent opportunistic infection (14 cases). The presentation was subacute in 70% and the most important symptom was fever. Only 3 (9%) had septic emboli in chest X-ray. The affected valve was mitral in 31 patients (91%). The blood culture was negative in 21 episodes (62%) and only in 6, Staphylococcus aureus was isolated. The mortality was 18% and 68% were outcome without any problem.

Left-sided endocarditis in patients with HIV infection is a very serious problem. It seems to affect to patients with severe immunosuppression and the culture blood may be negative. Its diagnosis is difficult and the mortality is elevated.