Infective endocarditis in a group of patients at risk for HIV infection: analysis of 63 episodes
Abstract number: 1135_241
Valencia M.E., Moreno V., Enríquez A., Guinea J., Gonzalez-Lahoz J.
To study epidemiological, clinical, microbiological and evaluative characteristics of infective endocarditis (IE) in a group of patients at risk for HIV infection and to determine the influence of HIV virus in the patients evolution.
All IE (defined according Durack criteria) diagnosed between 1996 and 2004 have been studied. Data were collected with regard to the clinical, laboratory and demographics characteristics of patients as well as results of blood cultures and data on clinical outcome. Statistical study was done with SPSS program (11.0).
There were diagnosed 63 episodes of IE between 55 patients. Only one of them was not intavenous drug adict (IVDA) and most were men (81%). Mean age was 33 years (2049) and 20 (32%) had had a previous episode of IE. There was HIV infection in 56 patients (89%), 26 of them had AIDS and mean CD4+ was 248 mm3 (4-810). Only 12 (19%) were receiving highly active antiretroviral therapy (HAART) and 49 (78%) had also HVC infection. The onset was acute in 43 cases (68%). All the patients were febrile, 48 (76%) had respiratory symptoms and 33 (52%) cardiac murmur. Chest X-ray was normal only in nine cases (14%) and septic embolisms were observed in 28 (44%). The vegetations were detected by two-dimensional echocardiography and tricuspid was the most frequent affected valve (53 cases; 84%). Mitral valve endocarditis was diagnosed in five cases (8%), aortic in 6 (9.5%) and pulmonary in 3 (5%). There was valvular insufficiency in 39 cases. Blood culture was negative in 28 episodes (44%), there was three cases of polymicrobial IE (4.8%) and S. aureus was the most frequently isolated organism (19 episodes; 30%). Patients were treated with antibiotics during 24 weeks, but 7 (11%) needed treatment for 6 weeks. Therapy was depended on the organisms susceptibility but initially the subjects were empirically treated with cloxacillin with or without tobramycin. Ten patients, all with left sided IE (16%), developed cardiac insufficiency, 7 (11%) renal insufficiency, 2 (3%) arterial emboli and 8 (12.7%), all with HIV infection, dead.
Most of the cases of IE in patients with HIV infection are seen in subjects without HAART, probably because IE is more related with drug abuser than with HIV, CD4+ lymphocyte count or HAART use. For this reason IE may be an important disease with an elevated mortality rate in patients with HIV infection, overall they will probably be active IVDA without HAART.
|Session name:||XXIst ISTH Congress|
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