Being HIV-positive does not mean worse outcome if hospitalised for community acquired pneumonia

The clinical outcome of HIV-positive patients hospitalised with community acquired pneumonia is no worse than that of HIV-negative patients, according to an international study published in the August 15^th edition of Clinical Infectious Diseases (now available online). The investigators found that, even though the median CD4 cell count of the HIV-positive patients in the study was below 200 cells/mm³, the period of hospitalisation was comparable between HIV-positive and HIV-negative patients, as was the mortality rate.

Community acquired pneumonia is an important cause of illness and death in HIV-positive individuals. Investigators wished to evaluate if there was any difference in the outcome between hospitalised HIV-positive and HIV-negative patients with community acquired pneumonia, and if HIV-positive patients were hospitalised with less severe forms of pneumonia than HIV-negative individuals.

The investigators designed an international, multicentre study involving 58 HIV-positive individuals and 174 age-matched HIV-negative individuals. Recruitment to the study was between the summer of 2001 and the spring of 2003.

To be included in the study, patients were required to have an abnormal chest x-ray, a new or worse cough, and an abnormal temperature and/or an abnormal serum leukocyte count. Individuals were determined to have achieved clinical stability when their cough or shortness of breath improved; they ceased to be febrile for a sustained period, and when their whole blood count normalised and their oral intake and gastrointestinal absorption were adequate. Time to clinical stability was the number of days in hospital. Data on the number of deaths were also collected.

HIV-positive and HIV-negative patients had a comparable mean age (39 and 42 years respectively). Data concerning CD4 cell count were available for 37 HIV-positive individuals, the median count being 192 cells/mm³, indicative of significant immune suppression.

The time to clinical stability, the number of days of hospitalisation were comparable between HIV-positive and HIV-negative patients. Total mortality was also comparable at 4%.

In addition, the investigators found, however, HIV-positive patients were often hospitalised with less severe pneumonia than age-matched HIV-negative individuals.

“This study indicates that clinical outcomes for hospitalised patients with community acquired pneumonia are not influenced by the presence of HIV infection”, conclude the investigators. They add, “our data also suggest that the decision to hospitalise a patient with community acquired pneumonia should not be influenced by the presence of HIV infection.”