HIV Infection as Risk Factor for Death among Hospitalized Persons with Candidemia, South Africa, 2012-2017

Abstract

We determined the effect of HIV infection on deaths among persons >18 months of age with culture-confirmed candidemia at 29 sentinel hospitals in South Africa during 2012-2017. Of 1,040 case-patients with documented HIV status and in-hospital survival data, 426 (41%) were HIV-seropositive. The in-hospital case-fatality rate was 54% (228/426) for HIV-seropositive participants and 37% (230/614) for HIV-seronegative participants (crude odds ratio [OR] 1.92, 95% CI 1.50-2.47; p<0.001). After adjusting for relevant confounders (n = 907), mortality rates were 1.89 (95% CI 1.38-2.60) times higher among HIV-seropositive participants than HIV-seronegative participants (p<0.001). Compared with HIV-seronegative persons, the stratum-specific adjusted mortality OR was higher among HIV-seropositive persons not managed in intensive care units (OR 2.27, 95% CI 1.47-3.52; p<0.001) than among persons who were (OR 1.56, 95% CI 1.00-2.43; p = 0.05). Outcomes among HIV-seropositive persons with candidemia might be improved with intensive care.

Keywords: Candida; Candida albicans; HIV/AIDS and other retroviruses; South Africa; candidemia; fungi; mortality; sepsis.

Figure 1

Flowchart demonstrating selection of 1,040 cases of candidemia from a 6-year surveillance period for secondary data analysis, South Africa, 2012–2017.

Figure 2

Kaplan-Meier analysis for 1,023 participants with candidemia during a 30-day period after the diagnosis of culture-confirmed candidemia by HIV infection status (outcome date missing for 17 participants), South Africa, 2012–2017. HIV = 0: HIV-seronegative; HIV = 1: HIV-seropositive; p value for log-rank test <0.001.