Objectives: To compare the fever course after starting therapy in patients diagnosed of active tuberculosis with and without HIV infection and evaluate the usefulness of empiric antituberculous therapy in diagnosing the disease.
Methods: Review of clinical records from all patients meeting the following criteria for three years: recovery of Mycobacterium tuberculosis from any clinical sample, knowledge of serological status to HIV, initial therapy of tuberculosis, absence of ther causes of fever identified, and not being treated with drugs which potentially could interfere with the course of fever during their hospital stay.
Results: At admission HIV-positive patients with tuberculosis were afebrile in a significantly lower proportion than HIV-negative patients (17% vs. 54%, respectively; p < 0.001). After initiating antituberculous therapy, the median time to fever resolution was similar in both HIV-positive and HIV-negative patients (6 and 4 days, respectively). After two weeks of therapy, 25% of HIV-positive patients and 23% HIV-negative patients still had fever. No factor was identified which could predict the delay in resolution of fever.
Conclusions: The course of fever was similar in both HIV-positive and HIV-negative patients after initiating antituberculous therapy. This empirical therapy may be useful in diagnosing tuberculosis, as fever resolved in the first two weeks of therapy in most patients.