Background: Community-acquired pneumonia (CAP) is a frequent respiratory complication in HIV-infected (HIV + ) patients even in the highly active antiretroviral therapy (HAART) era. HIV+ patients are 25 times more likely to develop pneumonia. Purpose: The aim of this study was to determine the prognostic factors of 30 day mortality in CAP in HIV+ patients. Methods: We carried out a retrospective study that included all HIV+ patients with CAP admitted in Department of Infectious Diseases of a Portuguese central hospital between January 2012 and December 2013. Socio-demographic variables, comorbidities, smoking status, CD4+ cell count, HAART status, laboratory and radiologic findings were recorded. Results: We included 51 patients: mean age 44.0±9.6 years, 90.2% men. Overall 30 day mortality was 23.5% (n=12). All non-survivors had CD4+<200/mm 3 and were smokers; 83.1% were not on HAART and in 75% CURB65 score was <3. Predictors of mortality were CURB65≥3 (OR 9.8; p=0.011); severe sepsis/septic shock (OR 7.6; p<0.001), neurologic disease (OR 4.01; p=0.013) and CD4+<200/mm 3 (OR 1.4; p=0.038). There were no statistical differences between survivors and non-survivors regarding chronic hepatitis, pack-years of smoking, HAART status, duration of HIV infection, C-reactive protein, leucocyte count, radiologic features and microbiologic isolates. Conclusions: Almost one quarter of HIV+ patients with CAP died. Mortality was higher in patients with severe sepsis, CD4+<200/mm3, neurologic disease or CURB65≥3, which should point us to a more aggressive treatment. We also highlight that 75% of non-survivors had CURB65<3 which calls into question the usefulness of low scores in HIV+ patients.
Marçôa et al. (Mon,) studied this question.