Clinical outcomes of HIV-infected patients hospitalized with bacterial community-acquired pneumonia

Abstract

The presence of HIV infection did not influence the clinical outcomes of CAP among patients assessed at CAPO centers. It is not intended that our results be extrapolated to populations receiving limited healthcare for advanced HIV disease, malnourishment and parasitic diseases.

HIV-Associated Bacterial Pneumonia

“…One area that has been particularly controversial, both in all cause CAP and specifically in pneumococcal pneumonia is whether the outcome is worse in HIV-infected versus HIV-uninfected persons [1]. While some studies have suggested that the outcome is no different [1,78,79], more recent studies in both allcause CAP and pneumococcal pneumonia have suggested that the mortality of CAP is higher in HIV-infected patients [1,35,69,82]. In one of these studies, which was in patients with bacteraemic pneumococcal pneumonia, when cases were stratified according to age and severity of illness, HIV infected patients had a higher mortality with a significant trend for increasing mortality in those with lower CD4 cell counts [35,69].…”

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

“…26 HIV-positive patients in this study had significantly lower severity scores than their seronegative counterparts, similar to what was observed in the CAPO international cohort study. 20,21 In our case, the difference can be explained by HIV-positive patients being younger, as age >65 years is a prognostic feature which contributes one point in the CURB-65 score, and there were no differences with respect to agecontrolled scores. This finding means other unaccounted factors guided clinicians in their decision to admit.…”

“…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. 5,13,15,[17][18][19] HIV infection is a known risk factor for bacteraemia, 5,19 but apparently not for higher mortality 5,18,20,21 or time to clinical stability. 20,21 Evidence on prediction of severity and resulting guidance on risk stratification and related management remains heterogeneous.…”

“…5,13,15,[17][18][19] HIV infection is a known risk factor for bacteraemia, 5,19 but apparently not for higher mortality 5,18,20,21 or time to clinical stability. 20,21 Evidence on prediction of severity and resulting guidance on risk stratification and related management remains heterogeneous. 13,15,17,18 In order to assess CAP severity on presentation and consequently guide therapeutic options, several prediction scales based on clinical and laboratorial criteria have been developed, which are nowadays widely used and endorsed by clinical societies worldwide.…”

Pulmonary Manifestations of HIV Disease

“…These risk factors include not being on ART, presence of pneumococcal antigen in urine for patients with pneumococcal pneumonia 169 and comorbid states such as liver cirrhosis (mostly from alcohol abuse) 170 . Compared with HIV sero negative patients and in situations where health care delivery may be described as optimal HIV infection appears not to increase the mortality risk in hospitalized patients with Community Acquired Pneumonia and neither does it lead to prolongation of hospital stay 171,172 . In patients with acute respiratory failure admitted to the ICU, the risk of death is related to extent of organ failure such as need for mechanical ventilation and use of vasopressor agents rather than HIV parameters such as CD4 T cell count, HIV plasma viral load or use of ART 173 .…”