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Published on: June 11, 2011
Clinical features and outcome of spontaneous bacterial peritonitis in HIV-infected cirrhotic patients: a case-control
E Shaw1, J Castellote, M Santín
1Department of Infectious Diseases, IDIBELL, Hospital Universitari de Bellvitge, C/ Feixa Llarga s/n, 08907 L'Hospitalet, Barcelona, Spain.
Abstract:
The aim of this study was to evaluate the clinical characteristics and outcome of spontaneous bacterial peritonitis, a serious complication in patients with cirrhosis and ascites, in an HIV-infected cirrhotic population. Thirty-five HIV-infected cirrhotic patients who developed spontaneous bacterial peritonitis during a 12-year period were compared with 70 non-HIV-infected cirrhotic subjects. Patients were matched according to the date of the first episode of spontaneous bacterial peritonitis. A bacteriological diagnosis was made in 37 of 47 (79%) and in 50 of 97 (52%) episodes in the HIV group and in the non-HIV group, respectively (p=0.003), and Streptococcus pneumoniae was isolated more frequently in the HIV group (22 vs. 8%, p=0.02). Median survival after the initial diagnosis of spontaneous bacterial peritonitis was 2.9 and 14.0 months in the HIV group and non-HIV group, respectively. Age (hazard ratio [HR] 1.04; 95%CI 1.01-1.07), male sex (HR 2.55; 95%CI 1.34-4.83), Child-Pugh score at first spontaneous bacterial peritonitis episode (HR 1.29; 95%CI 1.10-1.54), renal impairment at first spontaneous bacterial peritonitis episode (HR 2.61; 95%CI 1.49-4.62), and HIV infection (HR 9.81; 95%CI 4.03-23.84) were independently associated with higher long-term mortality after the first diagnosis of spontaneous bacterial peritonitis. In conclusion, HIV-infected cirrhotic patients with spontaneous bacterial peritonitis have a higher rate of bacteriological diagnosis and a more frequent pneumococcal etiology than non-HIV-infected subjects. Life expectancy in these patients, once spontaneous bacterial peritonitis has developed, is poor. These data are particularly relevant for determining the optimal time for liver transplantation in this population.
Insights
HIV-infected cirrhotic patients with spontaneous bacterial peritonitis (SBP) face poorer outcomes and higher rates of bacterial diagnosis, particularly pneumococcal infections. Survival is significantly reduced in this population compared to non-HIV infected individuals.
Area of Science:
- Hepatology
- Infectious Diseases
- HIV Medicine
Background:
- Spontaneous bacterial peritonitis (SBP) is a severe complication in cirrhosis with ascites.
- HIV infection may alter the clinical presentation and outcomes of SBP.
Purpose of the Study:
- To compare clinical characteristics and outcomes of SBP in HIV-infected versus non-HIV-infected cirrhotic patients.
- To identify factors associated with mortality in HIV-infected cirrhotic patients with SBP.
Main Methods:
- Retrospective comparison of 35 HIV-infected cirrhotic patients with 70 matched non-HIV-infected cirrhotic subjects diagnosed with SBP over 12 years.
- Analysis of bacteriological diagnosis rates, causative pathogens, and survival data.
Main Results:
- Higher bacteriological diagnosis rates (79% vs. 52%) and more frequent isolation of Streptococcus pneumoniae (22% vs. 8%) in HIV-infected patients.
- Median survival was significantly shorter in HIV-infected patients (2.9 months vs. 14.0 months).
- Independent predictors of mortality included age, male sex, Child-Pugh score, renal impairment, and HIV infection.
Conclusions:
- HIV-infected cirrhotic patients with SBP exhibit distinct microbiological profiles and poorer survival.
- HIV infection is a strong independent predictor of long-term mortality post-SBP diagnosis.
- These findings are crucial for optimizing management and considering liver transplantation in this vulnerable group.
