       Document 0016
 DOCN  M9610016
 TI    Neutropenia and bacterial infection in acquired immunodeficiency
       syndrome.
 DT    9601
 AU    Moore RD; Keruly JC; Chaisson RE; Johns Hopkins University School of
       Medicine, Baltimore, Md, USA.
 SO    Arch Intern Med. 1995 Oct 9;155(18):1965-70. Unique Identifier :
       AIDSLINE MED/96006135
 AB    BACKGROUND: In human immunodeficiency virus (HIV) disease, neutropenia
       occurs most commonly in patients who are also severely immunosuppressed.
       It is not currently known whether neutropenia is an independent risk
       factor for the development of bacterial infection, which is a
       potentially serious complication of advanced HIV disease. METHODS: We
       compared the incidence of bacterial infection between 118 neutropenic
       patients (absolute neutrophil count [ANC], < 1 x 10(9)/L) and 118
       nonneutropenic patients matched for CD4+ lymphocyte count, use of
       injecting drugs, and follow-up time from a demographically heterogeneous
       urban cohort of HIV-infected patients followed up longitudinally at the
       Johns Hopkins Hospital. The incidence of serious infection was analyzed
       separately for patients with an ANC of less than 1, less than 0.75, or
       less than 0.5 x 10(9)/L. RESULTS: There were no statistically
       significant associations found between neutropenia and several
       individual bacterial infections, including bacteremia, pneumonia,
       endocarditis, bacterial enterocolitis, and infection of normally sterile
       sites for any level of neutropenia. However, for all these infections
       combined, the adjusted relative risk for the occurrence of bacterial
       infection was 2.33 (95% confidence interval, 1.00 to 5.40; P = .05) for
       patients with an ANC of less than 1 x 10(9)/L and 7.92 (95% confidence
       interval, 1.18 to 53.2; P = .03) for those with an ANC of less than 0.5
       x 10(9)/L. The incidence of serious bacterial infection ranged from two
       to three infections per 100 person-months of neutropenia for patients
       with an ANC of less than 1 x 10(9)/L and three to five infections per
       100 person-months of neutropenia for patients with an ANC of less than
       0.5 x 10(9)/L for all bacterial infections combined. CONCLUSIONS: Our
       matched cohort analysis indicates that neutropenia is an independent
       risk factor for bacterial infection in patients with advanced HIV
       disease. Given the incidence of infection, the cost-effectiveness of
       interventions to prevent neutropenia in advanced HIV disease should be
       assessed.
 DE    Adult  AIDS-Related Opportunistic Infections/*COMPLICATIONS  Bacterial
       Infections/*ETIOLOGY/VIROLOGY  Female  Human  Incidence  Male
       Matched-Pair Analysis  Multivariate Analysis
       Neutropenia/*COMPLICATIONS/VIROLOGY  Support, Non-U.S. Gov't  Support,
       U.S. Gov't, P.H.S.  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

