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International Journal of Infectious Diseases (2010) 14, e22—e27

http://intl.elsevierhealth.com/journals/ijid

Clinical outcomes of HIV-infected patients hospitalized with bacterial community-acquired pneumonia
Maricar Malinis a, John Myers b, Jose Bordon a,c,*, Paula Peyrani a, Rama Kapoor a, Raul Nakamatzu a, Gustavo Lopardo d, Antoni Torres e, Charles Feldman f, M. Allen a, F. Arnold a,Julio Ramirez a
Division of Infectious Disease, University of Louisville School of Medicine, Louisville, KY, USA School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA c Department of Medicine, Section of Infectious Diseases, Providence Hospital, 1150 Varnum Street, NE, Washington, DC 20017, USA d Hospital Benardo Houssay, Buenos Aires, Argentina e Serveide Pneumologia, Hospital Clinic IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain f Division of Pulmonology, Department of Medicine, Johannesburg Hospital and University of the Witwatersrand, Johannesburg, South Africa
b a

Received 4 November 2008; received in revised form 10 February 2009; accepted 1 March 2009 Corresponding Editor: Mark Holodniy, California, USA

KEYWORDS
HIVinfection; Community-acquired pneumonia; Outcome

Summary Background: There are limited and conflicting data on clinical outcomes of community-acquired pneumonia (CAP) among HIV-infected patients. Methods: Secondary analyses of clinical outcomes of CAP were performed for 118 patients with HIV infection and 2790 patients without HIV infection enrolled in the Community-Acquired Pneumonia Organization(CAPO) international study. After adjustment for significant confounders, the effect of HIV infection on length of stay (LOS) and time to clinical stability (TCS) were examined by survival analyses and overall mortality and CAP-related mortality by logistic regression methods. Results: After adjusting for significant confounders, hospitalized HIV-infected patients with CAP did not have longer timesto reach clinical stability (HR 1.126; 95% CI 0.917—1.391; p = 0.251) or longer stays in the hospital (HR 1.191, 95% CI 0.979—1.449; p = 0.080). In addition, HIV infection did not significantly influence overall mortality rates (OR 1.205, 95% CI 0.686—2.116; p = 0.517) or CAP-related mortality rates (OR 1.338; 95% CI 0.623—3.725; p = 0.355).

* Corresponding author. Tel.: +1 202 269 7747; fax: +1202 269 7892. E-mail address: jmbord01@gwise.louisville.edu (J. Bordon). 1201-9712/$36.00 # 2009 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.ijid.2009.03.001

Outcomes of HIV-infected patients with bacterial CAP

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Conclusion: The presence of HIV infection did not influence the clinical outcomes of CAP among patientsassessed at CAPO centers. It is not intended that our results be extrapolated to populations receiving limited healthcare for advanced HIV disease, malnourishment and parasitic diseases. # 2009 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Introduction
Pulmonary infections are a major cause of morbidity and mortality in persons infected with HIV.1Pneumonia due to unspecified organisms has been reported to be the leading cause of death among HIV-infected individuals in the USA during 1990—1999.2 The introduction of highly active antiretroviral therapy (HAART) has led to a notable decline in opportunistic infections (OI), however bacterial pneumonia remains prevalent.3 In addition, bacterial communityacquired pneumonia (CAP) has been reported tobe a common cause of hospitalization among HIV-infected patients.4,5 The etiology, risk and prognostic factors of CAP among hospitalized HIV-infected patients have been examined. However, studies comparing clinical outcomes of CAP in patients with and without HIV infection are limited and results are conflicting. To date, five studies have evaluated the outcomes of mortality in HIV-infected...