Introduction: Nontyphoidal Salmonella (NTS) has been associated with HIV from the
outset of the HIV pandemic. The few NTS studies done in Africa and America have not
documented the impact of HIV on clinical-microbiologic features and mortality in patients
with NTS infection. This study determined the association between HIV serostatus and
mortality proportion, clinical presentation, length of hospital stay, frequency of invasive
NTS infection recurrence, NTS serotypes and estimated the population attributable fraction
of mortality due to HIV among patients with invasive NTS infection in South Africa.
Methods: Secondary data from enteric diseases national surveillance in South Africa from
2003 to 2006 were analysed as a cross sectional study. A total of 1 398 subjects with
known HIV serostatus were obtained after data cleaning. Data analysis was done in Stata
using chi squared test for categorical variables and Wilcoxon rank sum test / Kruskal-
Wallis test for continuous variables. Logistic regression models were used to quantify the
associations, and adjust for confounders and effect modification. Population attributable
fraction was calculated to quantify the impact of HIV on mortality.
Results: Majority (82.26%) of patients were HIV positive. The frequency pattern of HIV
positive serostatus in different age groups coincided with that of invasive NTS. The overall
mortality was 32.00%. HIV positive patients had a higher proportion (35.79 %) of
mortality than HIV negative patients (15.55 %) (P<0.001). Fifty five percent of deaths in
this study population were attributed to HIV infection. In multivariate models, HIV
positive patients were more likely than HIV negative patients to die (OR = 2.50, 95% CI
1.69- 3.70), to develop lower respiratory tract infection (LRTI) (OR = 1.89, 95% CI,1.34-
2.65), to have recurrence of invasive NTS (OR = 3.90, 95% CI 1.41-10.77), to stay less
than 16 days in hospitals (OR = 1.61, 95% CI, 1.08-2.40) and to be infected with
Salmonella serotype Typhimurium infection (OR = 2.59, 95% CI 1.91-3.51). There were
no significant differences in temperature, cardiac arrest, meningitis and site of specimen
isolation (p>0.05).
Discussion: The major limitation to this study was poor data quality of the surveillance
system, including missing HIV serostatus hence the findings cannot be generalized to
patients with unknown HIV status.
Conclusion: HIV infection is common among patients with invasive NTS and is
associated with excess mortality, LRTI, fewer than 16 days of hospital stay, recurrent
invasive NTS infection and Salmonella Typhimurium. It is important for clinicians to rule
out HIV infection in patients with invasive NTS especially those presenting with LRTI and
Salmonella Typhimurium infection in addition to recurrent NTS infection, which is a wellknown
feature associated with HIV.
Recommendation: Since these patients received antimicrobials and had considerable
mortality, the first line treatment of invasive NTS should be reviewed especially to HIV
positive patients by investigating resistance patterns and conducting a clinical trial of
newer and effective antimicrobials.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/6951 |
| Date | 18 May 2009 |
| Creators | Mtandu, Rugola |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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