Abstract
Introduction: The use of combination antiretroviral therapy and antibiotic prophylaxis has shifted the spectrum of pulmonary disease seen in HIV-infected patients towards that observed in non-immunocompromised patients.
Objectives: To describe the clinical presentation of community-acquired pneumonia (CAP) requiring admission in HIV patients and identify predictors of adverse outcome.
Methods: We retrospectively reviewed all admissions for CAP in HIV adults over 12 years.Clinical, laboratorial and radiological data were analyzed; CURB-65 score was calculated.Adverse outcome was defined as need for invasive mechanical ventilation (IMV) or death.
Results: Thirty-two admissions were included (96,9% male; mean age 46 ± 12,2 years).The majority of patients didn't use antiretroviral therapy (87,5%) and were severely immunosuppressed (71,4% with CD4 cell counts<200/mm3).Patients presented with an acute illness characterized by fever, cough, dyspnea and occasionally chest pain.Acute respiratory failure was found in eleven episodes (34,4%).Focal infiltrate was the most frequent radiographic finding (78,1%).Among the identified pathogens, S. pneumoniae was the most common (37.5%);three injection drug users had pneumococcal bacteremia.Four patients needed IMV;the mortality rate was 9,4%.CD4 cell count <200/mm3 and multilobar pneumonia were significantly associated with adverse outcome (p=0,045 and p=0,001, respectively).Most patients (59,4%) had a low CURB-65 risk score (0–1);high-risk score (3-5) was not associated with increased mortality.
Conclusions: HIV-infected patients with CAP presented much in the same way as those without HIV.CD4 cell count <200/mm3 and multilobar involvement were predictive of adverse outcome.
- Copyright ©the authors 2016
