Abstract: A new Mozambican guideline for management of fever in HIV-infected adults requires malaria testing and systematic consideration of specific alternative diagnoses (eg, tuberculosis and bacterial infections) in addition to malaria. We conducted a prospective observational study of the guideline's performance. Of 258 HIV-infected subjects with axillary temperature ≥37.5° C or history of fever, 76.0% improved, 13.6% died or were hospitalized, and 10.5% were lost to follow-up. In multivariate analyses, factors associated with adverse outcomes were bacterial blood stream infection, syndromically diagnosed tuberculosis, lower CD4+ T-lymphocyte count, no antiretroviral therapy, lower body mass index, lower hemoglobin, and nonprescription of antibiotics.
*Friends in Global Health, LLC, Maputo, Mozambique;
†Vanderbilt Institute for Global Health, Nashville, TN; and
‡Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN.
Correspondence to: Paula E. Brentlinger, MD, MPH, Vanderbilt Institute for Global Health, 2525 West End Avenue, Suite 750, Nashville, TN 37203 (e-mail: email@example.com).
Supported by the President's Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention under the terms of Cooperative Agreement U2GPS000631 to Vanderbilt University. The REDCap (Research Electronic Data Capture; http://www.project-redcap.org/) online database that we used for initial data entry and management was supported by grant number UL1 TR000445 from NCATS/NIH.
Presented in part at the 20th Conference on Retroviruses and Opportunistic Infections, May 3–6, 2013, Atlanta, GA, Abstract #876.
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the National Institutes of Health.
Conception and design: P.E.B., T.D.M., W.P.S., E.V., S.H.V.; acquisition of data: P.E.B., M.B., T.D.M., L.M., W.P.S., E.V.; analysis and interpretation of data: P.E.B., T.D.M., W.P.S., E.V.; drafting of manuscript: P.E.B., T.D.M., S.H.V.; and critical revision and approval of manuscript: All.
Received February 14, 2014
Accepted July 01, 2014