Fever of unknown origin in HIV‐infected patients: a critical analysis of a retrospective series of 57 cases

Abstract

Abstract. Objectives. The aim of the study was to assess the incidence and aetiology of fever of unknown origin in human immunodeficiency virus (HIV)‐infected patients, and to evaluate the usefulness of the main diagnostic procedures. Design. A retrospective study. Setting and subjects. We reviewed the records of 270 HIV‐infected patients who were hospitalized for the first time in a department of infectious and tropical diseases during the 27 month study period. Main outcome measures. Fifty‐seven patients (21 %) had a history of fever of unknown origin. Results. The aetiology was found in 49 cases (86 %). The major cause of the fever was mycobacteriosis: atypical mycobacteria in 10 cases, Mycobacterium tuberculosis in 10, mycobacteria of unspecified type in two, and BCG strain in one. A liver biopsy and a thoracic CT scan greatly contributed to the diagnosis of mycobacterial infection. Seventeen patients were given empiric antimycobacterial therapy as a therapeutic test, of whom seven had a favourable response. The other main causes of fever were cytomegalovirus infection in five patients, leishmaniasis in four, and lymphoma in four. Conclusions. Fever of unknown origin is a frequent occurrence in the course of HIV infection, and mycobacterial infection should be considered as a first‐line diagnosis in such cases. The place of empiric antimycobacterial therapy in the diagnostic strategy requires further evaluation, but appears to be an alternative to multiple investigative procedures.