Urinary tract infection in men with AIDS.

OBJECTIVE--To investigate whether bacteriuria and, specifically, symptomatic urinary tract infection (UTI) occur with increased frequency in men with HIV infection. METHODS--In this cross-sectional study we investigated three groups of men, aged from 18 to 50 years. Group A was composed of patients with a diagnosis of AIDS; Group B, of patients without HIV infection, and group C of patients with asymptomatic HIV infection. Patients with any known predisposing factor for UTI were excluded from the study. A clean-catch midstream urine sample was collected from each patient on the first day of hospital admission (groups A and B) or during a visit to the outpatient clinic (group C). Bacteriuria was diagnosed when > or = 100,000 colony forming units/ml, urine were grown. RESULTS--There were 415 patients, 151 in group A, 170 in group B and 94 in group C. Bacteriuria was significantly more frequently in group A (20 cases, 13.3%) than in groups B (3 cases, 1.8%, p = 0.00007) and C (3 cases, 3.2%, p = 0.009). Ten cases of bacteriuria in group A (6.6%) were symptomatic while no case of symptomatic UTI was seen in groups B (p = 0.0004) and C (p = 0.008). The frequency of UTI in homosexual men with AIDS (7 cases, 6.7%) was not significantly different from that observed in men with AIDS who denied homosexuality (3 cases, 6.5%). E coli was the predominant pathogen associated with UTI. Although adequate response to a two-week course of antibiotics was observed in most cases, an in-hospital mortality rate of 20% was found among AIDS patients with symptomatic UTI. CONCLUSIONS--In the present study, the frequency of bacteriuria and symptomatic UTI was found to be increased in men with AIDS. E coli was the predominant pathogen in these cases. These data suggest that symptomatic UTI may represent a relevant cause of morbidity for men with AIDS.

A simplified surveillance case definition of AIDS derived from empirical clinical data. The Clinical AIDS Study Group, and the Working Group on AIDS case definition.

A clinical AIDS case definition is needed for surveillance in countries where the CDC case definition is not practical. To derive such a definition, we compared 110 HIV-seropositive and 135 randomly selected HIV-seronegative adult medical-ward inpatients in Brazil. Multivariate analysis of clinical signs and symptoms and simple diagnoses resulted in a discriminant function with sensitivity of 89% and specificity of 96% in predicting for AIDS. These data were the empirical basis for a clinical definition of AIDS in adults drafted in a Caracas, Venezuela, workshop sponsored by the Pan American Health Organization. The revised "Caracas" definition presented here requires a positive HIV serology, the absence of cancer or other cause of immunosuppression, plus > or = 10 cumulative points, as follows: Kaposi's sarcoma (10 points); extrapulmonary/noncavitary pulmonary tuberculosis (10); oral candidiasis or hairy leukoplakia (5); cavitary pulmonary/unspecified tuberculosis (5); herpes zoster < 60 years of age (5); CNS dysfunction (5); diarrhea > or = 1 month (2); fever > or = 1 month (2); cachexia or > 10% weight loss (2); asthenia > or = 1 month (2); persistent dermatitis (2); anemia, lymphopenia, or thrombocytopenia (2); persistent cough or any pneumonia except TB (2); and lymphadenopathy > or = 1 cm at > or = 2 noninguinal sites for > or = 1 month (2). This definition has a sensitivity of 95% and a specificity of 100% (91% without HIV serology) when applied to the Brazilian patients in this study. The Caracas definition has been adopted by Brazil, Honduras, and Surinam, and is in validation elsewhere. The use of a reasonably sensitive and specific case definition commensurate with available diagnostic resources should facilitate AIDS surveillance in developing countries.