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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP-
dc.contributor.authorSILVA JR., Joao Manoel-
dc.contributor.authorSANTOS, Sigrid De Sousa dos-
dc.identifier.citationJOURNAL OF THE INTERNATIONAL AIDS SOCIETY, v.16, article ID 17344, 8p, 2013-
dc.description.abstractIntroduction: Intensive care mortality of HIV-positive patients has progressively decreased. However, critically ill HIV-positive patients with sepsis present a worse prognosis. To better understand this condition, we propose a study comparing clinical, etiological and inflammatory data, and the hospital course of HIV-positive and HIV-negative patients with severe sepsis or septic shock. Methods: A prospective observational study enrolling patients with severe sepsis or septic shock associated or not with HIV infection, and admitted to intensive care unit (ICU). Clinical, microbiological and inflammatory parameters were assessed, including C-reactive protein (CRP), procalcitonin (PCT), interleukin-6, interleukin-10 and TNF-alpha. Outcome measures were in-hospital and six-month mortality. Results: The study included 58 patients with severe sepsis/septic shock admitted to ICU, 36 HIV-positive and 22 HIV-negative. All HIV-positive patients met the criteria for AIDS (CDC/2008). The main foci of infection in HIV-positive patients were pulmonary and abdominal (p = 0.001). Fungi and mycobacteria were identified in 44.4% and 16.7% of HIV-positive patients, respectively. In contrast, the main etiologies for sepsis in HIV-negative patients were Gram-negative bacilli (36.4%) and Gram-positive cocci (36.4%) (p = 0.001). CRP and PCT admission concentrations were lower in HIV-positive patients (130 vs. 168 mg/dL p = 0.005, and 1.19 vs. 4.06 ng/mL p = 0.04, respectively), with a progressive decrease in surviving patients. Initial IL-10 concentrations were higher in HIV-positive patients (4.4 pg/mL vs. 1.0 pg/mL, p = 0.005), with moderate accuracy for predicting death (area under receiver-operating characteristic curve = 0.74). In-hospital and six-month mortality were higher in HIV-positive patients (55.6 vs. 27.3% p = 0.03, and 58.3 vs. 27.3% p = 0.02, respectively). Conclusions: The course of sepsis was more severe in HIV-positive patients, with distinct clinical, etiological and inflammatory characteristics.-
dc.description.sponsorshipFAPESP (Fundacao de Amparo a Pesquisa do Estado de Sao Paulo) [2006/03362-7]-
dc.publisherINT AIDS SOCIETY-
dc.relation.ispartofJournal of the International AIDS Society-
dc.subjectinflammatory markers-
dc.subject.otherhiv-infected patients-
dc.subject.otherreactive protein crp-
dc.subject.otherantiretroviral therapy-
dc.subject.otherprocalcitonin pct-
dc.subject.otherresponse syndrome-
dc.subject.otherseptic shock-
dc.titleSepsis in AIDS patients: clinical, etiological and inflammatory characteristics-
dc.rights.holderCopyright INT AIDS SOCIETY-
dc.subject.wosInfectious Diseases-
dc.type.categoryoriginal article-
dc.type.versionpublishedVersion-, Sigrid De Sousa dos:Univ Sao Paulo, Fac Med, Dept Infect & Parasit Dis, Sao Paulo, Brazil; Univ Fed Sao Carlos, Dept Med, BR-13565905 Sao Carlos, SP, Brazil-
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