Etiologies of Fever of Unknown Origin in HIV/AIDS Patients, Hanoi, Vietnam

Abstract

Background: Prolonged fever is a challenge for clinicians in managing patients with HIV/AIDS. Their TCD4 counts can be helpful in the diagnosis and treatment. This study aimed to determine several common etiologies of prolonged fever and their distribution in different TCD4 count levels in HIV/AIDS patients.Methods: A cross-sectional, retrospective and prospective study was conducted on 195 HIV/AIDS patients with fever of unknown origin admitted to National Hospital for Tropical Diseases from January 2016 to June 2019. Clinical parameters, immune status, and etiologies for each patient were recorded. Odds ratio was used to compare the distribution of common etiologies in two different TCD4 count levels, including <50 cells/mm3 and ≥50 cells/mm3.Results: The proportion of opportunistic infections and non-infectious etiologies was 93.3% and 3.6%, respectively. Tuberculosis was the most common opportunistic infection (46.7%), followed by Talaromycosis (29.2%) and Pneumocystis jiroveci (20.5%). Tuberculosis was predominant in all stratified CD4 levels. Most cases with Talaromycosis had CD4 counts below 50 cells/mm3. 53.8% of cases were infected by one pathogen. There was no difference between the number of concurrent etiologies and T-CD4 levels. Conclusions: Opportunistic infections, especially tuberculosis, are still the leading cause of prolonged fever in HIV/AIDS patients. Talaromyces marnefei should be screened in patients with CD4 <50 cells/mm3. This study implies that guidelines regarding providing the appropriate treatment for FUO-HIV patients based on the CD4 cells count should be developed that may reduce the burden of clinicians in managing HIV/AIDS patients.