Community acquired lung respiratory infections in HIV-infected patients: Microbial etiology and outcome

Background : The aim of this study are to examined the correlation of CD4+ cell count and HIV-RNA level with the etiology of CAP in hospitalized HIV-infected patients Methods: Prospective observational study of consecutive adult patients with HIV infection seen in the ED with the diagnosis of CAP. Results : We studied 331 HIV patients with CAP, mean age of 42.1 ± 9.5 yrs. Mean CD4+ cell count 281.3 ± 248.3 /mm 3 . 128 (39%) patients had CD4+ cell count lower than 200/mm 3 . The mean HIV-RNA level 234,236 ± 905,6 copies/ml. 83(25%) patients had HIV-RNA level <50 copies/ml. HIV infection had been diagnosed prior hospital admission in 274 (83%) patients and 57(17%) patients the diagnosis of HIV infection was in the episode of pneumonia. Independent predictors of bacterial CAP in multivariate analysis were days of symptoms ≤5 (OR 2.6), C-reactive protein level ≥22 mg/dl (OR 4.3), and co-infection with HCV (OR 2.3). Current smoker (OR 0.2) or ex-smoker (OR 0.2, 95% CI 0.04-0.8), previous antibiotic (OR 3.5), C-reactive protein level <22 mg/dl (OR 12.5), WBC count ≤4,000 x10 9 cell/L (OR 3.9), LDH ≥450 U/L (OR 13.1), and multilobar affectation (OR 5.3) were independent predictors of pneumocystic CAP in the multivariate analysis. LDH ≥450 U/L (OR 4.3) and mechanical ventilation (OR 22.6) were the only variables independently associated with 30-day hospital mortality. Conclusion: Bacterial pneumonia was significantly higher than pneumonia for P. jiroveci. S. pneumoniae continues been the main pathogens involved in CAP, regard CD4+ cell count stratus and HIV-RNA levels. Our result indicated there are several risk factors to help us recognise bacterial from Pneumocystic infections.