Antibiotic therapy in severe sepsis in HIV-positive patients

Severe sepsis has become one of the most frequent causes of hospitalization in intensive care units for patients diagnosed with HIV infection. The difficulty in setting a sepsis diagnosis in HIV-positive patients led to the systematic exclusion of these patients from studies on sepsis, which limited the understanding of its impact on the evolution of the disease. Our study aims to evaluate the etiology of sepsis in immunocompromised HIV-positive patients and the evolution after antibiotic therapy. 30 patients diagnosed with HIV infection and sepsis, admitted to our clinic between January 2008 and April 2012, were followed. Severity of illness, time since diagnosis, CD4 count, antiretroviral treatment, incidence of severe sepsis, and organ dysfunctions were registered. Patients were between 1 and 61 years of age, most of them were classified into stages B2, B3 and C3, requiring hospitalization for a period ranging from 14 to 28 days, with an average of 16.7 days and a median of 18 days, while 8 required monitoring in the intensive care unit. In about 40% of cases, the starting point was an infection of the lower respiratory tract, but also of the upper urinary tract and skin infections. Evolution and mortality in sepsis associated with HIV/AIDS infection depend on the presence of organ failure and are less influenced by the level of immunodepression, complex antibiotic therapy being the cornerstone in controlling patients.