Neutropenia in patients with HIV infection: a case control study in a cohort of 1403 patients between 1982 and 1993.

The relationship between neutropenia and increased risks of severe infections in patients with HIV infection and the factors associated with neutropenia-induced infections was studied by a retrospective comparative study using matched case-control analysis. A database (1982-1993) of 1870 patients with HIV infection was searched, and from 484 patients with neutropenia, 177 patients were paired with 177 nonneutropenic control subjects. Descriptive analysis and development of logistic models were used to determine factors associated with the risk of developing bacterial infections and major fungal infections. The occurrence of severe bacterial and fungal infections was significantly higher in neutropenic patients (p < or = 0.001). Bacteremia was more common in neutropenic patients than in nonneutropenic patients (p < or = 0.02) in the matched case-control analysis. Risk of severe infections was strongly associated with the neutrophil count (p < or = 0.05), clinical stage, and hemoglobin level (p < 0.005) when paired patients were compared. More neutropenic episodes occurred between 1991 to 1993, possibly due to prolonged survival and the increasing use of concomitant myelosuppressive therapies. Neutropenic HIV-infected patients are significantly at risk of developing severe infections at the end-stage of HIV disease, and this may have a major impact on hospitalization and death. Preventing neutropenia could dramatically improve the quality of life of these patients.