TY - JOUR T1 - Community-acquired lung respiratory infections in HIV-infected patients: microbial aetiology and outcome JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/09031936.00155813 SP - erj01558-2013 AU - Catia Cilloniz AU - Antoni Torres AU - Eva Polverino AU - Albert Gabarrus AU - Rosanel Amaro AU - Encarnacion Moreno AU - Santiago Villegas AU - Mar Ortega AU - Josep Mensa AU - Maria Angeles Marcos AU - Asuncion Moreno AU - Jose M. Miro Y1 - 2014/01/01 UR - http://erj.ersjournals.com/content/early/2014/02/13/09031936.00155813.abstract N2 - We describe the aetiology of community-acquired pneumonia (CAP) in HIV-infected patients, risk factors for bacterial or Pneumocystis jirovecii CAP and prognostic factors of 30-day mortality. This was a prospective observational study of 331 consecutive adult CAP cases in HIV-infected patients (January 2007 to July 2012). 128 (39%) patients had CD4+ cell counts <200 per mm3 and 99 (43%) ha HIV RNA levels <200 copies per mL on antiretroviral therapy. Streptococcus pneumoniae was the most frequent microorganism in the group with CD4+ cell counts ≥200 per mm3; P. jirovecii was the most frequent microorganism in the group with CD4+ cell counts <200 per mm3 and in patients with HIV RNA ≥200 copies per mL. Predictors of bacterial CAP were: time with symptoms ≤5 days (OR 2.6, 95% CI 1.5–4.4), C-reactive protein level ≥22 mg·dL−1 (OR 4.3, 95% CI 2.3–8.2) and hepatitis C virus co-infection (OR 2.3, 95% CI 1.4–3.9). White blood cell count ≤4×1012 per L (OR 3.7, 95% CI 1.2–11.5), lactate dehydrogenase (LDH) level ≥598 U·L−1 (OR 12.9, 95% CI 4.2–39.7) and multilobar infiltration (OR 5.8, 95% CI 1.9–19.5) were predictors of P. jirovecii. Overall 30-day mortality was 7%. Appropriate antibiotic treatment (OR 0.1, 95% CI 0.03–0.4), LDH ≥598 U·L−1 (OR 6.2, 95% CI 1.8–21.8) and mechanical ventilation (OR 22.0, 95% CI 6.2–78.6) were the variables independently associated with 30-day mortality. The described predictors may help clinicians to distinguish between bacterial and P. jirovecii pneumonia in patients with suspected or confirmed HIV infection. Clinical risk factors in HIV patients to distinguish between bacterial and Pneumocystis jirovecii pneumonia http://ow.ly/sV2hf ER -