Fever of Unknown Origin (FUO) in HIV Infection in the Era of Antiretroviral Treatment (ART) in India: Development of a Simple Diagnostic Algorithm.
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Date
2015
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Abstract
Objective: Fever of unknown origin (FUO) is a challenging problem among people living with HIV
(PLHIV). With increasing access to Anti-retroviral treatment (ART), the spectrum of causes of FUO
has evolved in the developed world. This study evaluated the etiology of FUO among PLHIV in the
era of ART in India.
Methodology: This prospective study was conducted at a tertiary-care institution in New Delhi,
India. Sixty four PLHIV with a diagnosis of FUO were assessed by detailed clinical evaluation and
immunological assessment. Specific investigations to identify the etiology of fever: microbiological
and radiological investigations, bone marrow and histopathological examination of biopsies were
performed. A simple diagnostic algorithm for FUO was developed based on the findings. Results: Sixty five episodes of FUO were studied. Seventy percent of subjects were men, 76%
were <40 years of age, and 39% were receiving ART. The mean CD4 count was 156.57±178.43
cells/mm3 (5 to 1144 cells /mm3) and 23% patients had CD4 counts <50 cells/mm3. The mean
duration of fever was 11.26±8.54 weeks. Infections were the most common cause for FUO, with
Tuberculosis the most common (61.54%), particularly disseminated tuberculosis (41.54%).
Cryptococcal meningitis (7.69%), bacterial pneumonia (4.62%), pyogenic abscesses (4.62%),
Pneumocystis jirovecii pneumonia (PCP) (3.08%), visceral leishmaniasis (3.08%) were other
infections observed. Non-infectious etiologies including lymphoma (4.62%) and progressive
multifocal leucoencephalopathy (PMLE) (3.08%) were also seen. The etiology remained
undiagnosed in 6.15% episodes. Importantly, two or more concurrent etiologies of fever were seen
in 60% of patients.
Conclusion: Infections especially Tuberculosis remain the most common cause of FUO in PLHIV
even in the era of ART in developing countries like India. Multiple concurrent infections and a rising
trend to non-infectious causes are being observed. A simple diagnostic algorithm will help
diagnose majority of FUO even at the peripheral centers.
Description
Keywords
Fever of unknown origin, FUO, pyrexia of unknown origin, HIV
Citation
Anuradha S, Ghosh Sandeep, Dewan Richa, Kaur Ravinder, Rajeshwari K. Fever of Unknown Origin (FUO) in HIV Infection in the Era of Antiretroviral Treatment (ART) in India: Development of a Simple Diagnostic Algorithm. British Journal of Medicine and Medical Research. 2015; 7(10): 839-846.