HIV-infected persons have a propensity for MRSA SSTI and a high rate of recurrent disease. The reasons for the elevated rates of MRSA infections among HIV-infected persons appear to be multifactorial, but may be

mitigated with optimized HIV control and reductions in associated risk factors. The occurrence of methicillin-resistant Staphylococcus aureus (MRSA) infections has risen dramatically in the past decade. Initially a nosocomial pathogen, MRSA is now prevalent in the community and has become the most common cause of skin and soft tissue infections (SSTIs) [1, 2]. Furthermore, a large number of healthy persons are carriers of the organism and may serve as reservoirs within the community [3]. HIV-infected persons

are at a heightened risk of MRSA infections [4-6]. To date, there are no comprehensive published reviews of the literature on MRSA colonization and infection Everolimus mw among HIV-infected persons during the highly active antiretroviral therapy (HAART) era. This paper provides a review of the literature and clinical management of MRSA infections among HIV-infected persons. We searched PubMed (MEDLINE) using the keywords “HIV” and “MRSA” to identify relevant references. Our search was restricted to articles published in the HAART era (January 1996 to January 2011). We also reviewed major articles on MRSA in the general population to provide comparison data. Reference lists of the articles were also examined to identify additional citations. Colonization with S. aureus is important as it precedes and increases the risk for infection [7-9]. In Galunisertib clinical trial a study among HIV-infected patients

colonized with MRSA at baseline, 37% developed an SSTI, whereas only 8% of those not colonized developed an SSTI Metalloexopeptidase (P < 0.001) [10]. Most commonly, infection is caused by the colonizing strain [9]. Compared with the general population, HIV-infected persons are at an increased risk for MRSA colonization [9]. In the HAART era, prevalence estimates of MRSA colonization among HIV-infected persons have been ∼4% (range 0–17%) [9-18] compared with 1.5% in the general population [19]. A recent study among HIV-infected out-patients examining carriage at multiple body sites found the highest prevalence at the nares (3.3%) followed by the perigenital (1%), throat (1%) and axillae (0.2%) regions [17]. It has been reported that the addition of a groin culture for detecting MRSA carriage can increase detection by 24% [18]. Risk factors for MRSA colonization among HIV-infected persons include poor immune status (e.g. low CD4 cell count), recent exposure to antibiotics, illicit drug use, recent hospitalizations, prior MRSA colonization or infection, and chronic skin disease [9, 10, 12-14, 18, 20, 21]. The use of trimethoprim-sulfamethoxazole (TMP-SMX) appears protective against MRSA colonization [13]. Recent studies have linked high-risk sexual behaviours to MRSA colonization.