Brucellosis in patients infected with the human immunodeficiency virus

Brucellosis has been described rarely in patients infected with HIV, despite the fact that eradication of intracellular brucellae is largely dependent on cell-mediated immunity. The characteristics of all patients with HIV infection and brucellosis seen in seven Spanish hospitals are reported. Since the beginning of the AIDS epidemic, 12 HIV-infected patients were diagnosed with brucellosis (8 with cultures positive for Brucella spp., 4 with high anti-Brucella antibody titers). Most patients were male and intravenous drug users. Eleven patients had no symptoms of HIV infection when first diagnosed with brucellosis and had relatively preserved cellular immunity (median CD4 + cell count 588, range 136-1006). There was a clear epidemiologic antecedent for acquisition of brucellosis in 11 patients. Clinical symptoms included fever, arthromyalgia, and sweating in all patients; four patients presented with focal disease. All patients had high agglutinin titers, and eight of nine had cultures positive for Brucella. Therapy with doxycycline and streptomycin was curative in all cases. Two patients experienced a recurrence of symptoms after initial treatment, although no microbiological relapses were documented after a median follow-up period of 18 months. HIV infection does not seem to increase the incidence of brucellosis. Since most cases occur in asymptomatic patients with relatively preserved immunity, the epidemiology, clinical presentation, diagnosis, response to therapy, and outcome are similar to those observed in non-HIV infected patients.