Predicting of Poor Outcomes for Patients HIV-associated Community-Acquired Pneumonia: Who are at risk and how reduce mortality in such patients?

Coominity-acquired pneumonia (CAP) in individuals with HIV results from multiple risk factors ,particularly immune defects a CD4 count decrease ,especially when below< 100 cells/mm3 continue to be a risk fro pneumonia due to routine bacterial pathogens.Assessment of risk factors which are responsible for poor prognosis in patients with CAP associated with HIV infection is important and interesting for further evaluation of possible their modification and through that reduction mortality rate and and improved the patient outcomes.We aimed to investigate the risk factors predicting poor outcomes in patients with CAP developed in individuals with HIV infection.We conducted a retrospective cohort study involved patients with diagnosed CAP who were admitted to the pulmonary nad critical care unit of medical university teaching hospital,Baku city,Azerbaijan,from January of 2018 to December of 2022.One hundred ninety three adult patients (>18 yerars old) with CAP were enrolled to the study.The number of patients with CAP associated with HIV infection was 59 (30.9% of all CAP patients ) and 16 of them we have identified accidently in our hospital.In our study recurrent pneumonia episodes ,especially in patients with CD4<500cells/mm3 was higher and the severity of immunodeficiency has predicted the frequency and severity of recurrent pneumonia episodes(9.5[2.8-18/7];p<0.01) and the Cd4<100 cells/mm3 count was major risk factor predicting ICU admission and bacteremia with severe sepsis/septic shock (20.9[10.4-30.8];p<0.001).We have found five major and independent risk factors predicting in-hospital mortality in our study:severe malnutrition;CD4<100cells/mm3;radiographic progression of the disease;P/F<250;and bacteremia with severe sepsis/septic shock .We identified factors associated with an increased risk of ICU admission and fatal outcomes which could help identify patients who might benefit from anti-pneumococcal vaccination ,antiretroviral treatment ,adequate nutrition and ventilatory support as well as determine prognosis.Our findings should be validated by studies with larger samples of patients.