Changes in the etiology, incidence and prognosis of acute lower respiratory track infections in human immunodeficiency virus patients

Abstract

a b s t r a c tAim: To describe the, incidence, the changes in the etiology and the prognosis of lower respiratory tract infection (LRTI) in HIV infected patients, presenting by the first time to the Emergency Department (ED), during years 2000-2010. Study design: Prospective collection of data. Metbods: Data were collected on the first visit of HIV-infected patients at our ED due to a LRTI, (defined according to the criteria of the European Respiratory Society), between 1/1/2000 and 31/12/2010. A series of epidemiological and laboratory variables as well as the need for admission to the intensive care unit (ICU). LRTI etiology were also collected. The influence ofthe mentioned variables on 30-day mortality were analyzed. Results: One hundred thirty one patients were included. LRTI represented 27% of visits to the ED by HIV-infected patients. Mean age was 39±9 years. 72% of patients were males. 18% required admission to the ICU. The most frequent LRTI was pneumonia by P. jiroveci in 35 cases, bacterial penumonia in 27 and pulmonary tuberculosis in 20. LRTI incidence gradually reduced significantly over time from 6.13 × 1000 patients/year in year 2000 to 0.23 × 1000 patients/year in 2010 (p<0.05). Overall mortality was 14%. Logistic regression analysis showed that admission to ICU (p<0.004) and viral load (p<0.029) were independent variables predicting mortality. Conclusion: LRTI is a pathology with a decreasing incidence, probably related to the widespread utilization increased of HAART regimens. lts etiology has also been changing, but with a non negligible mortality, mostly when ICU admission was required.© 2014 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.Cambios en la etiología, incidencia y pronóstico de la infección respiratoria aguda de vías bajas en pacientes infectados por el virus de la inmunodeficiencia humana Infecc Microbiol Clin. 2014;xxx(xx):xxx-xxx así como la necesidad de ingreso en una unidad de cuidados intensivos (UCI). Se estudió la etiología de la IRVB y la incidencia. Finalmente se analizaron la influencia de las variables con la mortalidad a 30 días. Resultados: Se incluyeron un total de 131 pacientes. La edad media fue de 39 ± 9 años. El 72% de los pacientes eran varones y el 18% de los pacientes requirieron ingreso en la UCI. La IRVB más frecuente fue la neumonía por P. jirovecci, seguida de la neumonía bacteriana en 27 y la tuberculosis pulmonar en 20. La incidencia de IRVB se ha ido reduciendo gradualmente de forma significativa, 6,13 × 1.000 pacientes/año en 2000 a 0,23 × 1.000 pacientes/año en 2010 (p < 0,05). El análisis de regresión logística mostró que la única variable que predijo mortalidad fue el ingreso en UCI (p < 0,05; OR: 73,01). Conclusión: La IRVB es una enfermedad cuya incidencia y etiología han ido disminuyendo y cambiando respectivamente, probablemente en relación con la utilización generalizada del TAR. Sin embargo, todavía presenta una mortalidad nada despreciable, que es mayor cuando el paci...

CURB-65 and other markers of illness severity in community-acquired pneumonia among HIV-positive patients

“…28 Stemming from different methodologies, there is disagreement in the association between lower CD4 cell counts and worse outcomes, including multilobar consolidation, longer time to clinical stability and increased mortality. Some studies have reported no impact of this marker on CAP outcome, 11,17 whereas others have conversely found a significant impact on mortality, prompting authors to recommend admission of all patients in the <200 cells/mL subgroup. 13,15,29 Taking into account our results, in addition to CURB-65 scores, low CD4 cell counts seem to be independent predictive factors in the severity assessment of HIV-positive patients presenting with CAP.…”

“…3,4 HIV infection has been consistently described as a major risk factor for CAP, [5][6][7][8] which is considered a stage 3 disease in the World Health Organization HIV staging classification 9 and an AIDS-defining illness by the American Centers for Disease Control and Prevention (CDC) when recurrent. 10 Despite a reported decline in incidence over the last two decades, [7][8]11 this condition remains frequent in this population, with its relative burden presently greater than before. [11][12][13][14] In fact, CAP among HIVinfected patients has been found in some studies performed in high-income settings to be the most prevalent severe non-AIDS-defining infection and one of the most frequent reasons for hospital admission.…”

“…10 Despite a reported decline in incidence over the last two decades, [7][8]11 this condition remains frequent in this population, with its relative burden presently greater than before. [11][12][13][14] In fact, CAP among HIVinfected patients has been found in some studies performed in high-income settings to be the most prevalent severe non-AIDS-defining infection and one of the most frequent reasons for hospital admission. 11,12,15,16 Low CD4 cell counts, uncontrolled viral replication and absence of HAART have been associated with increased incidence.…”

“…[11][12][13][14] In fact, CAP among HIVinfected patients has been found in some studies performed in high-income settings to be the most prevalent severe non-AIDS-defining infection and one of the most frequent reasons for hospital admission. 11,12,15,16 Low CD4 cell counts, uncontrolled viral replication and absence of HAART have been associated with increased incidence. 6,12,[14][15][16] Research has addressed this topic since the beginning of the HAART era, focusing on the course and outcome of CAP in HIV-positive patients.…”

Acute respiratory infection: first clinical manifestation of active infection with cytomegalovirus in HIV patients presenting to the emergency department

“…(5) Although the incidence of RI has decreased, and its etiology has changed due to the introduction of cART, it has a non-negligible mortality and often requires admission to an intensive care unit (ICU). (6) The study objectives were to clarify, in a cohort of HIV-infected patients, if the usual clinical manifestations of AICMV have changed, and if RI has an important role in the presentation of AICMA, Furthermore, we wanted to find out which microorganisms cause it, and what the 30-day mortality is.…”