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A Reduction in Adult Blood Stream Infection and Case Fatality at a Large African Hospital following Antiretroviral Therapy Roll-Out

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Feasey, Nicholas ORCID: https://orcid.org/0000-0003-4041-1405, Houston, Angela, Mukaka, Mavuto, Komrower, Dan, Mwalukomo, Thandie, Tenthani, Lyson, Jahn, Andreas, Moore, Mike, Peters, Remco P. H., Gordon, Melita A., Everett, Dean B., French, Neil, van Oosterhout, Joep J., Allain, Theresa J. and Heyderman, Robert (2014) 'A Reduction in Adult Blood Stream Infection and Case Fatality at a Large African Hospital following Antiretroviral Therapy Roll-Out'. PLoS ONE, Vol 9, Issue 3, e92226.

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Abstract

Introduction

Blood-stream infection (BSI) is one of the principle determinants of the morbidity and mortality associated with advanced HIV infection, especially in sub-Saharan Africa. Over the last 10 years, there has been rapid roll-out of anti-retroviral therapy (ART) and cotrimoxazole prophylactic therapy (CPT) in many high HIV prevalence African countries.

Methods

A prospective cohort of adults with suspected BSI presenting to Queen's Hospital, Malawi was recruited between 2009 and 2010 to describe causes of and outcomes from BSI. Comparison was made with a cohort pre-dating ART roll-out to investigate whether and how ART and CPT have affected BSI. Malawian census and Ministry of Health ART data were used to estimate minimum incidence of BSI in Blantyre district.

Results

2,007 patients were recruited, 90% were HIV infected. Since 1997/8, culture-confirmed BSI has fallen from 16% of suspected cases to 10% (p<0.001) and case fatality rate from confirmed BSI has fallen from 40% to 14% (p<0.001). Minimum incidence of BSI was estimated at 0.03/1000 years in HIV uninfected vs. 2.16/1000 years in HIV infected adults. Compared to HIV seronegative patients, the estimated incidence rate-ratio for BSI was 80 (95% CI:46–139) in HIV-infected/untreated adults, 568 (95% CI:302–1069) during the first 3 months of ART and 30 (95% CI:16–59) after 3 months of ART.

Conclusions

Following ART roll-out, the incidence of BSI has fallen and clinical outcomes have improved markedly. Nonetheless, BSI incidence remains high in the first 3 months of ART despite CPT. Further interventions to reduce BSI-associated mortality in the first 3 months of ART require urgent evaluation.

Item Type: Article
Subjects: WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.2 Therapy
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.5 Complications
WH Hemic and Lymphatic Systems > Hematologic Diseases. Immunologic Factors. Blood Banks > WH 120 Hematologic diseases (General or not elsewhere classified)
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.1371/journal.pone.0092226
Depositing User: Lynn Roberts-Maloney
Date Deposited: 23 Apr 2015 10:24
Last Modified: 06 Feb 2018 13:09
URI: https://archive.lstmed.ac.uk/id/eprint/5098

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