To evaluate the role of Campylobacter disease after the introduction of highly active antiretroviral therapy (HAART; introduced in late 1996), patients with at least one microbial isolation associated with consistent gastrointestinal or systemic symptoms were retrieved among patients referring every year to a tertiary centre in Bologna, Italy since 1991. Sixteen human immunodeficiency virus (HIV)-infected patients with campylobacteriosis (11 males and 5 females; aged 35.6±5.2 years; 11 diagnosed during 1991-96 and 5 during 1997-2001) were identified. The introduction of HAART caused a significant drop in the absolute frequency of campylobacteriosis (odds ratio=1.79; P0.0001). A case of haematogenous dissemination has not occurred since 1997, compared with 7 episodes diagnosed until 1996 (P0.03). Systemic involvement was observed only before the introduction of HAART (P0.03). 10 patients (9 in the pre-HAART period) received chronic co-trimoxazole prophylaxis. In vitro susceptibility assays showed elevated resistance to first generation cephalosporins (93.7%) and an increasing sensitivity rate to co-trimoxazole (43.7%), tetracyclines (50%), macrolides and chloramphenicol (62.5%), gentamicin (75%), 2nd or 3rd generation cephalosporins (81.2%) and fluoroquinolones (100%), in absence of significant temporal variations. An 8- to 18-day antimicrobial course performed with associated aminoglycosides and cephalosporins (n=8), quinolones (n=4), or macrolides (n=2) or cephalosporins (n=2) alone led to clinical and microbiological cure. Relapses caused by pathogens bearing the same antibiotic susceptibility pattern occurred in 6 patients after 3-8 weeks, all in the pre-HAART period (P0.05); one case proved lethal.
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