Title
Community-acquired lung respiratory infections in HIV-infected patients: Microbial aetiology and outcome
Date Issued
01 January 2014
Access level
open access
Resource Type
journal article
Author(s)
Torres A.
Polverino E.
Gabarrus A.
Amaro R.
Moreno E.
Villegas S.
Ortega M.
Mensa J.
Marcos M.A.
Asuncion M.
Miro J.M.
Centro de Investigación Biomédica en Red-Enfermedades Respiratorias
Publisher(s)
European Respiratory Society
Abstract
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 mm3and 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 mm3and 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 ≤4×1012per 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.
Start page
1698
End page
1708
Volume
43
Issue
6
Language
English
OCDE Knowledge area
Enfermedades infecciosas
Epidemiología
Scopus EID
2-s2.0-84901845839
PubMed ID
Source
European Respiratory Journal
ISSN of the container
09031936
Sources of information:
Directorio de Producción Científica
Scopus