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mGem: Sepsis and antimicrobial resistance in the context of advanced HIV disease

Summary

This review examines how serious infections (sepsis) from bacteria and fungi affect people with advanced HIV disease, particularly in hospitals. The infections have become more dangerous due to antimicrobial resistance, and many cases go undiagnosed because of limited laboratory capabilities. The paper calls for better diagnostic tools and treatment strategies tailored to resource-limited settings where most advanced HIV disease cases occur.

Background

Sepsis triggered by bloodstream infections is a significant driver of HIV-related mortality, particularly among inpatients with advanced HIV disease. The incidence, etiology, and outcomes of bloodstream infections in this population are poorly defined, with causative pathogens often unknown.

Objective

To review existing evidence on sepsis and bloodstream infections in advanced HIV disease, examining bacterial and fungal pathogens, antimicrobial resistance patterns, and identifying knowledge gaps to inform future intervention strategies.

Results

Advanced HIV disease patients demonstrate increased risk of bloodstream infections with antimicrobial-resistant organisms and higher mortality rates. Pathogen etiology has shifted with increased antiretroviral coverage, showing movement away from classical AIDS-defining pathogens toward healthcare-associated organisms.

Conclusion

Further research is crucial to design and refine interventions before, during, and after hospital admission to reduce sepsis-related mortality in patients with advanced HIV disease, particularly in low- and middle-income countries.
  • Published in:mBio,
  • Study Type:Review,
  • Source: PMID: 40214248, DOI: 10.1128/mbio.00769-24
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