Objective To evaluate the epidemiology, clinical characteristics, diagnostic methods, and treatment outcomes of cases of Human Immunodeficiency Virus (HIV) combined with Nocardia infection.

Methods Retrospective analysis was conducted on the clinical data of 198 cases of HIV combined with Nocardia infection reported in literatures and abroad from January 1985 to August 2024. Chi-square test, logistic regression and linear discriminant analysis was compared the epidemiological and clinical differences between the single site infection and the disseminated infection group, as well as the survival group and the death group.

Results The average age of 198 co-infected cases with HIV and Nocardia infection was (39.50±12.01) years, including 163 males (82.32%). 48 cases had underlying diseases, and the mortality rate was 22.73%. The most common clinical symptoms are fever, cough/sputum, shortness of breath, headache, weight loss, etc. The clinical symptoms of the disseminated infection group were significantly higher than the single site infection (all P<0.05). Living in a subtropical region (adjusted Odds Ratio, aOR=4.08, 95% Confidence Interval, CI: 1.64−10.12), living in a monsoon climate zone (aOR=6.23, 95%CI: 2.22−17.48), being infected with Nocardia asteroides or Nocardia farcinica (aOR=2.48, 95%CI: 1.14−5.42), and having brain abscess (aOR=3.35, 95%CI: 1.26−8.89) were the main death risk factors of HIV combined with Nocardia infection cases(all P<0.05). The presence of skin abscess was a protective factor for death in HIV complicated with Nocardia infection cases (aOR=0.16, 95%CI: 0.03−0.78) (P<0.05). All cases were confirmed by microbiological examination, and 40.40% of cases underwent imaging diagnosis. The results of the drug sensitivity test indicated that the Nocardia is sensitive to linezolid, amikacin, imipenem, trimethoprim sulfamethoxazole, doxycycline, etc.

Conclusion The mortality rate of HIV combined with Nocardia infection is relatively high, and the infection site is mostly in the lungs. Special attention should be paid to co-infected individuals with Nocardia asteroides or Nocardia farcinica, brain abscess, and disseminated infections. For suspected cases of co-infection, early pathogen testing and drug sensitivity testing should be conducted to select appropriate treatment strategies in a timely manner.