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Frequency and risk factors of infectious complications in neutropenic patients infected with HIV
J L Meynard1, M Guiguet, S Arsac
1Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, Paris, France.
Objective:
To determine causes, incidence and factors associated with infections in neutropenic [polymorphonuclear neutrophil (PMN), 1000 x 10(6)/l] HIV-infected patients.
Design:
Prospective study.
Setting:
Infectious disease service of a 1000-bed university teaching hospital in Paris, France.
Patients:
HIV-infected patients with a PMN count of < 1000 x 10(6)/l confirmed on two occasions were included in the study. Baseline characteristics, cause of neutropenia and occurrence of infectious episodes were analysed.
Results:
The cause of neutropenia was lymphoma in four cases (6.5%), antineoplastic chemotherapy in seven (11.3%), zidovudine in 32 (51%), trimethoprim-sulphamethoxazole (TMP-SMX) in 28 (45%) and ganciclovir in 11 (18%). Fifteen patients (24%) developed infectious complications. Neutropenia induced by chemotherapy or lymphoma was more frequently complicate by infectious episodes (P = 0.02). Neutropenia in the previous 3 months (P = 0.05), presence of a central venous catheter (P = 0.05) and a trough PMN count (P = 0.02) were the three risk factors of infection retained in a logistic model.
Conclusion:
Neutropenia induced by zidovudine, gangiclovir or TMP-SMX, are less complicated by infectious episodes than neutropenia induced by antineoplastic chemotherapy. Overall, infectious episodes in neutropenic HIV-infected patients appear lower than in patients with haemobiologic malignancies.
Insights
Infections in neutropenic HIV patients are less common than in those with blood cancers. Chemotherapy-induced neutropenia poses a higher infection risk than drug-induced neutropenia.
Area of Science:
- Infectious Diseases
- Hematology
- HIV Medicine
Background:
- Neutropenia, characterized by a low polymorphonuclear neutrophil (PMN) count (< 1000 x 10(6)/l), is a significant concern in HIV-infected patients.
- Identifying causes and risk factors for infections in this vulnerable population is crucial for effective management.
Purpose of the Study:
- To investigate the causes, incidence, and associated factors of infections in neutropenic HIV-infected patients.
- To compare the infectious complication rates between different causes of neutropenia.
Main Methods:
- A prospective study was conducted at a university teaching hospital in Paris, France.
- HIV-infected patients with confirmed neutropenia (< 1000 x 10(6)/l PMN) were analyzed for baseline characteristics, neutropenia causes, and infectious episodes.
Main Results:
- Common causes of neutropenia included zidovudine (51%), trimethoprim-sulphamethoxazole (45%), and ganciclovir (18%).
- Fifteen percent of patients developed infectious complications, with neutropenia induced by chemotherapy or lymphoma showing a higher incidence (P = 0.02).
- Risk factors for infection included prior neutropenia (P = 0.05), central venous catheter presence (P = 0.05), and low PMN count (P = 0.02).
Conclusions:
- Neutropenia from zidovudine, ganciclovir, or TMP-SMX is associated with fewer infectious complications compared to chemotherapy-induced neutropenia.
- Infectious episodes in neutropenic HIV patients appear less frequent than in patients with hematologic malignancies.