Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Neutropenia and Bacterial Infection in Acquired Immunodeficiency Syndrome

Neutropenia and Bacterial Infection in Acquired Immunodeficiency Syndrome Abstract 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], <1×109/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 0.5×109/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 1×109/L and 7.92 (95% confidence interval, 1.18 to 53.2; P=.03) for those with an ANC of less than 0.5×109/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 1×109/L and three to five infections per 100 person-months of neutropenia for patients with an ANC of less than 0.5×109/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.(Arch Intern Med. 1995;155:1965-1970) References 1. Bodey GP, Buckley M, Sathe YS, Freireich EJ. Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Ann Intern Med . 1966;64:328-339.Crossref 2. Zon LI, Arkin C, Groopman JE. Haematologic manifestations of the human immunodeficiency virus (HIV). Br J Haematol . 1987;66:251-256.Crossref 3. Castella A, Cloxson TS, Mildvan D, Witt DH, Zalvsky R. The bone marrow in AIDS. Am J Clin Pathol . 1984;84:425-432. 4. Murphy MF, Metcalfe P, Waters AH, et al. Incidence and mechanism of neutropenia and thrombocytopenia in patients with human immunodeficiency virus infection. Br J Haematol . 1987;66:337-340.Crossref 5. Richman DD, Fischl MA, Grieco MH, et al. The toxicity of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex: a double-blind placebo controlled trial. N Engl J Med . 1987;317:192-197.Crossref 6. Polsky B, Gold JWM, Whimbey E, et al. Bacterial pneumonia in patients with the acquired immunodeficiency syndrome. Ann Intern Med . 1986;104:38-41.Crossref 7. Selwyn PA, Feingold AR, Hartel D, et al. Increased risk of bacterial pneumonia in HIV-infected intravenous drug users with AIDS. AIDS . 1988;2:267-272.Crossref 8. Caiaffa WT, Graham NMH, Vlahov D. Bacterial pneumonia in adult populations with human immunodeficiency virus (HIV) infection. Am J Epidemiol . 1993; 138:1-14. 9. Witt DJ, Craven D, McCabe WR. Bacterial infections in adult patients with the acquired immunodeficiency syndrome (AIDS) and AIDS-related complex. Am J Med . 1987;82:900-906.Crossref 10. Farber BF, Lesser M, Kaplan M, Woltmann J, Napolitano B, Armellino D. Clinical significance of neutropenia in patients with human immunodeficiency virus. Infect Control Hosp Epidemiol . 1991;12:429-434.Crossref 11. Keiser P, Higgs E, Peterson D. Neutropenia is with bacterial infections. Presented at the 10th International Conference on AIDS; August 10,1994; Yokohama, Japan. 12. Hengge UR, Brockmeyer NH, Goos M. Granulocyte colony—stimulating factor treatment in AIDS patients. Clin Invest . 1992;70:922-926.Crossref 13. Shaunak S, Bartlett JA. Zidovudine-induced neutropenia: are we too cautious? Lancet . 1989;2:91-92.Crossref 14. Northfelt DW, Polsky B. Bacteremia in persons with HIV infection. In: Volberding P, Jacobson MA, eds. AIDS Clinical Review 1991 . New York, NY: Marcel Dekker Inc; 1991:59-79. 15. Moore RD, Stanton D, Gopalan R, Chaisson RE. Racial differences in drug therapy for HIV disease in an urban community. N Engl J Med . 1994;330:763-768.Crossref 16. Rothman KJ. Modern Epidemiology . Boston, Mass: Little Brown & Co Inc; 1986. 17. Schimpff SC. Infections in the cancer patient: diagnosis, prevention, and treatment. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases . New York, NY: Churchill Livingstone Inc; 1990;2:2666-2675. 18. Rolston KVI, Bodey GP. Infections in patients with cancer. In: Holland JF, Frei E, Bast RC, Kufe DW, Morton DL, Weichselbamm RR, eds. Cancer Medicine . 3rd ed. Philadelphia, Pa: Lea & Febiger; 1993:2416-2441. 19. Hardy WD, Feinberg J, Finkelstein DM, et al. A controlled trial of trimethoprimsulfamethoxazole or aerosolized pentamidine for secondary prophylaxis of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome. N Engl J Med . 1992;327:1842-1848.Crossref 20. Caiaffa WT, Vlahov D, Graham NMH, et al. Drug smoking, Pneumocystis carinii pneumonia, and immunosuppression increase risk of bacterial pneumonia in human immunodeficiency virus-seropositive injection drug users. Am J Respir Crit Care Med . 1994;150:1493-1498.Crossref 21. Selwyn PA, Alcabes P, Hartel D, et al. Clinical manifestations and predictors of disease progression in drug users with human immunodeficiency virus infection. N Engl J Med . 1992;327:1697-1703.Crossref 22. Hirschtick R, Glassroth J, Jordan M, Wallace J. Bacterial pneumonia in patients infected with human immunodeficiency virus. Am Rev Respir Dis . 1993; 147( (suppl) ):A1003. 23. Dropulic LK, Leslie J, Eldred L, Zenilman J, Sears CL. Clinical manifestations and risk factors of Pseudomonas aeruginosa infection in patients with AIDS. J Infect Dis . 1995;171:930-937.Crossref 24. Steinhoff MC, Auerbach BS, Nelson KE, et al. Antibody responses to Haemophilus influenzae type vaccines in men with human immunodeficiency virus infection. N Engl J Med . 1991;325:1837-1842.Crossref 25. Janoff EN, Breiman RF, Daley CL, Hopewell PC. Pneumococcal disease during HIV infection: epidemiologic, clinical and immunologic perspectives. Ann Intern Med . 1992;117:314-324.Crossref 26. Lane HC, Masur H, Edgar LC, Whalen G, Rook AH, Fauci AS. Abnormalities of B-cell activation and immunoregulator in patients with the acquired immunodeficiency syndrome. N Engl J Med . 1983;309:453-458.Crossref 27. Ellis M, Gupta S, Galant S, et al. Impaired neutrophil function in patients with AIDS or AIDS-related complex: a comprehensive evaluation. J Infect Dis . 1988; 158:1268-1276.Crossref 28. Crawford J, Ozer H, Stoller R, et al. Reduction by granulocyte colony-stimulating factor of fever and neutropenia induced by chemotherapy in patients with small cell lung cancer. N Engl J Med . 1991;325:164-170.Crossref 29. Gabrilove JL, Jakubowski A, Scher H, et al. Effect of granulocyte colony-stimulating factor on neutropenia and associated morbidity due to chemotherapy for transitional cell carcinoma of the urothelium. N Engl J Med . 1988; 318:1414-1422.Crossref 30. Morstyn G, Campbell L, Souza LM, et al. Effect of granulocyte colony— stimulating factor on neutropenia induced by cytotoxic chemotherapy. Lancet . 1988;1:667-672.Crossref 31. Bronchud MH, Scarffe JH, Thatcher N, et al. Phase I/II study of recombinant human granulocyte colony-stimulating factor in patients receiving intensive chemotherapy for small cell lung cancer. Br J Cancer . 1987;56:809-813.Crossref 32. Jacobson MA, Stanley HD, Heard SE. Ganciclovir with recombinant methionyl human granulocyte colony-stimulating factor for treatment of cytomegalovirus disease in AIDS patients. AIDS . 1992;6:515-517.Crossref 33. Groopman JE, Mitsayasu TR, DeLeo MJ, Oette DH, Golde DW. Effect on recombinant human granulocyte-macrophage colony—stimulating factor on myelopoiesis in the acquired immunodeficiency syndrome. N Engl J Med . 1987; 317:593-598.Crossref 34. Miles SA, Mitsuyasu RT, Moreno J, et al. Combined therapy with recombinant granulocyte colony—stimulating factor and erythropoietin decreases hematologic toxicity from zidovudine. Blood . 1991;77:2109-2117. 35. Van Der Wouw PA, Van Leeuwen R, VanOerg J, Lange JMA, DAnner SA. Effects of recombinant human granulocyte colony—stimulating factor on leucopenia in zidovudine-treated patients with AIDS and AIDS related complex: a phase I/II study. Br J Haematol . 1991;78:319-324.Crossref 36. Kimura S, Matsuda J, Ikematsu S, et al. Efficacy of recombinant human granulocyte colony—stimulating factor on neutropenia in patients with AIDS. AIDS . 1990;4:1251-1255.Crossref 37. Baldwin GC, Gasson JC, Quan SC, et al. Granulocyte-macrophage colony— stimulating factor enhances neutrophil function in acquired immunodeficiency syndrome patients. Proc Natl Acad Sci USA . 1988;85:2763-2766.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Neutropenia and Bacterial Infection in Acquired Immunodeficiency Syndrome

Download PDF
6 pages

Loading next page...
 
/lp/american-medical-association/neutropenia-and-bacterial-infection-in-acquired-immunodeficiency-wp8CS3TYzZ

References (44)

Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1995.00430180067008
Publisher site
See Article on Publisher Site

Abstract

Abstract 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], <1×109/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 0.5×109/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 1×109/L and 7.92 (95% confidence interval, 1.18 to 53.2; P=.03) for those with an ANC of less than 0.5×109/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 1×109/L and three to five infections per 100 person-months of neutropenia for patients with an ANC of less than 0.5×109/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.(Arch Intern Med. 1995;155:1965-1970) References 1. Bodey GP, Buckley M, Sathe YS, Freireich EJ. Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Ann Intern Med . 1966;64:328-339.Crossref 2. Zon LI, Arkin C, Groopman JE. Haematologic manifestations of the human immunodeficiency virus (HIV). Br J Haematol . 1987;66:251-256.Crossref 3. Castella A, Cloxson TS, Mildvan D, Witt DH, Zalvsky R. The bone marrow in AIDS. Am J Clin Pathol . 1984;84:425-432. 4. Murphy MF, Metcalfe P, Waters AH, et al. Incidence and mechanism of neutropenia and thrombocytopenia in patients with human immunodeficiency virus infection. Br J Haematol . 1987;66:337-340.Crossref 5. Richman DD, Fischl MA, Grieco MH, et al. The toxicity of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex: a double-blind placebo controlled trial. N Engl J Med . 1987;317:192-197.Crossref 6. Polsky B, Gold JWM, Whimbey E, et al. Bacterial pneumonia in patients with the acquired immunodeficiency syndrome. Ann Intern Med . 1986;104:38-41.Crossref 7. Selwyn PA, Feingold AR, Hartel D, et al. Increased risk of bacterial pneumonia in HIV-infected intravenous drug users with AIDS. AIDS . 1988;2:267-272.Crossref 8. Caiaffa WT, Graham NMH, Vlahov D. Bacterial pneumonia in adult populations with human immunodeficiency virus (HIV) infection. Am J Epidemiol . 1993; 138:1-14. 9. Witt DJ, Craven D, McCabe WR. Bacterial infections in adult patients with the acquired immunodeficiency syndrome (AIDS) and AIDS-related complex. Am J Med . 1987;82:900-906.Crossref 10. Farber BF, Lesser M, Kaplan M, Woltmann J, Napolitano B, Armellino D. Clinical significance of neutropenia in patients with human immunodeficiency virus. Infect Control Hosp Epidemiol . 1991;12:429-434.Crossref 11. Keiser P, Higgs E, Peterson D. Neutropenia is with bacterial infections. Presented at the 10th International Conference on AIDS; August 10,1994; Yokohama, Japan. 12. Hengge UR, Brockmeyer NH, Goos M. Granulocyte colony—stimulating factor treatment in AIDS patients. Clin Invest . 1992;70:922-926.Crossref 13. Shaunak S, Bartlett JA. Zidovudine-induced neutropenia: are we too cautious? Lancet . 1989;2:91-92.Crossref 14. Northfelt DW, Polsky B. Bacteremia in persons with HIV infection. In: Volberding P, Jacobson MA, eds. AIDS Clinical Review 1991 . New York, NY: Marcel Dekker Inc; 1991:59-79. 15. Moore RD, Stanton D, Gopalan R, Chaisson RE. Racial differences in drug therapy for HIV disease in an urban community. N Engl J Med . 1994;330:763-768.Crossref 16. Rothman KJ. Modern Epidemiology . Boston, Mass: Little Brown & Co Inc; 1986. 17. Schimpff SC. Infections in the cancer patient: diagnosis, prevention, and treatment. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases . New York, NY: Churchill Livingstone Inc; 1990;2:2666-2675. 18. Rolston KVI, Bodey GP. Infections in patients with cancer. In: Holland JF, Frei E, Bast RC, Kufe DW, Morton DL, Weichselbamm RR, eds. Cancer Medicine . 3rd ed. Philadelphia, Pa: Lea & Febiger; 1993:2416-2441. 19. Hardy WD, Feinberg J, Finkelstein DM, et al. A controlled trial of trimethoprimsulfamethoxazole or aerosolized pentamidine for secondary prophylaxis of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome. N Engl J Med . 1992;327:1842-1848.Crossref 20. Caiaffa WT, Vlahov D, Graham NMH, et al. Drug smoking, Pneumocystis carinii pneumonia, and immunosuppression increase risk of bacterial pneumonia in human immunodeficiency virus-seropositive injection drug users. Am J Respir Crit Care Med . 1994;150:1493-1498.Crossref 21. Selwyn PA, Alcabes P, Hartel D, et al. Clinical manifestations and predictors of disease progression in drug users with human immunodeficiency virus infection. N Engl J Med . 1992;327:1697-1703.Crossref 22. Hirschtick R, Glassroth J, Jordan M, Wallace J. Bacterial pneumonia in patients infected with human immunodeficiency virus. Am Rev Respir Dis . 1993; 147( (suppl) ):A1003. 23. Dropulic LK, Leslie J, Eldred L, Zenilman J, Sears CL. Clinical manifestations and risk factors of Pseudomonas aeruginosa infection in patients with AIDS. J Infect Dis . 1995;171:930-937.Crossref 24. Steinhoff MC, Auerbach BS, Nelson KE, et al. Antibody responses to Haemophilus influenzae type vaccines in men with human immunodeficiency virus infection. N Engl J Med . 1991;325:1837-1842.Crossref 25. Janoff EN, Breiman RF, Daley CL, Hopewell PC. Pneumococcal disease during HIV infection: epidemiologic, clinical and immunologic perspectives. Ann Intern Med . 1992;117:314-324.Crossref 26. Lane HC, Masur H, Edgar LC, Whalen G, Rook AH, Fauci AS. Abnormalities of B-cell activation and immunoregulator in patients with the acquired immunodeficiency syndrome. N Engl J Med . 1983;309:453-458.Crossref 27. Ellis M, Gupta S, Galant S, et al. Impaired neutrophil function in patients with AIDS or AIDS-related complex: a comprehensive evaluation. J Infect Dis . 1988; 158:1268-1276.Crossref 28. Crawford J, Ozer H, Stoller R, et al. Reduction by granulocyte colony-stimulating factor of fever and neutropenia induced by chemotherapy in patients with small cell lung cancer. N Engl J Med . 1991;325:164-170.Crossref 29. Gabrilove JL, Jakubowski A, Scher H, et al. Effect of granulocyte colony-stimulating factor on neutropenia and associated morbidity due to chemotherapy for transitional cell carcinoma of the urothelium. N Engl J Med . 1988; 318:1414-1422.Crossref 30. Morstyn G, Campbell L, Souza LM, et al. Effect of granulocyte colony— stimulating factor on neutropenia induced by cytotoxic chemotherapy. Lancet . 1988;1:667-672.Crossref 31. Bronchud MH, Scarffe JH, Thatcher N, et al. Phase I/II study of recombinant human granulocyte colony-stimulating factor in patients receiving intensive chemotherapy for small cell lung cancer. Br J Cancer . 1987;56:809-813.Crossref 32. Jacobson MA, Stanley HD, Heard SE. Ganciclovir with recombinant methionyl human granulocyte colony-stimulating factor for treatment of cytomegalovirus disease in AIDS patients. AIDS . 1992;6:515-517.Crossref 33. Groopman JE, Mitsayasu TR, DeLeo MJ, Oette DH, Golde DW. Effect on recombinant human granulocyte-macrophage colony—stimulating factor on myelopoiesis in the acquired immunodeficiency syndrome. N Engl J Med . 1987; 317:593-598.Crossref 34. Miles SA, Mitsuyasu RT, Moreno J, et al. Combined therapy with recombinant granulocyte colony—stimulating factor and erythropoietin decreases hematologic toxicity from zidovudine. Blood . 1991;77:2109-2117. 35. Van Der Wouw PA, Van Leeuwen R, VanOerg J, Lange JMA, DAnner SA. Effects of recombinant human granulocyte colony—stimulating factor on leucopenia in zidovudine-treated patients with AIDS and AIDS related complex: a phase I/II study. Br J Haematol . 1991;78:319-324.Crossref 36. Kimura S, Matsuda J, Ikematsu S, et al. Efficacy of recombinant human granulocyte colony—stimulating factor on neutropenia in patients with AIDS. AIDS . 1990;4:1251-1255.Crossref 37. Baldwin GC, Gasson JC, Quan SC, et al. Granulocyte-macrophage colony— stimulating factor enhances neutrophil function in acquired immunodeficiency syndrome patients. Proc Natl Acad Sci USA . 1988;85:2763-2766.Crossref

Journal

Archives of Internal Medicine – American Medical Association

Published: Oct 9, 1995

There are no references for this article.