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Clin Infect Dis. 2014 Jan;58(1):79-92. doi: 10.1093/cid/cit596. Epub 2013 Sep 17.

Community-acquired bacterial bloodstream infections in HIV-infected patients: a systematic review.

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Division of Infectious Diseases, Center of Experimental and Molecular Medicine, Center of Infection and Immunity and Center of Tropical Medicine and Travel Medicine, Academic Medical Center, University of Amsterdam, The Netherlands.


Information on community-acquired bacterial bloodstream infections (BSIs) in individuals infected with human immunodeficiency virus (HIV) is limited. We conducted a systematic literature review. The case fraction of community-acquired bacterial BSIs in hospitalized patients is 20% and 30% in adults and children, respectively, compared to 9% in HIV-negative adults and children. Worldwide, the main pathogens of community-acquired BSI are nontyphoid salmonellae (NTS), Streptococcus pneumoniae, Escherichia coli, and Staphylococcus aureus, but regional differences are apparent, especially for S. pneumoniae. Compared to HIV-negative populations, HIV patients are particularly at risk to develop NTS bacteremia. Bacteremia incidence is related to immunosuppression, and antiretroviral therapy reduces the incidence of BSI in HIV patients (rate ratios, 0.63-0.02). Mortality rates varied between 7% and 46%. These results suggest that bacterial BSI is more likely to be found in HIV-positive than in HIV-negative patients upon hospitalization, and that causative pathogens vary by region.


AIDS; BSI; HIV; bacteremia; sepsis

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