HIV-Associated Community-Acquired Pneumonia: Why control of the HIV infection is Life-Saving for such Patients?

Background: Community-acquired pneumonia in individuals with HIV results from multiple risk factors, particularly immune defects a CD4 count decrease, especially when below<100cells/mm3 continues to be risk factor fro pneumonia due to routine bacterial pathogens. Assessment of risk factors which may help to assess the poor and good outcomes for patients with community-acquired pneumonia(CAP) in individuals with HIV for further evaluation of possibility their modification and through that reduction mortality rate. Objective: We aimed to investigate the risk factors associated with poor patient outcomes in patients with CAP in individuals with HIV infection and possibility of their modification in term on reduction of mortality rate. Methods: We conducted a retrospective cohort study involving patients with diagnosed CAP who were admitted to the pulmonary and critical care department of university teaching hospital One hundred ninety three adults(>18 years)patients with CAP were enrolled to the study. Results: Pneumonia was diagnosed as CAP when it occurs before and within 48 h of hospital admission .59 of 193 patients with CAP pneumonia was developed in individuals with HIV infection, and 16 of them the HIV infection was diagnosed in our hospital accidently. To identify risk factors associated with ICU admission and in hospital mortality were performed univariable and multivariable analysis .There was significant differences between age of patients regarding HIV infection.The patients with CAP in individuals with HIV were younger(P<0.01).Prior use of antibiotics (in the last 90 days) was common in patients with CAP +HIV(p<0.01) and commonly it was related to the presence of persistent high fever in individuals with HIV before development of CAP. Renal replacement therapy(RRT) was higher among patients with comorbidity (p<0.05) and common other finding in such patients was bacteremia related to catheter-driven bloodstream infection associated with multi-drug-resistant(MDR) pathogen associated pneumonia(p<0.01).Malnutrition was also common in patients with comorbidity and there was positive correlation between low BMI and ICU admission in patients(P<0.03).In patients with CAP+HIV most common radiological findings were bilateral and focal ,and segmental consolidation (P<0.04).Less incidences of lobar consolidation and unilateral localization of pneumonia(p<0.01).Cavitation and pleural effusions were common in patients with comorbidity(p<0.05 and <0.01; respectively).Septic shock also was common finding in patients with CAP +HIV(p<0.01). More severe disease course in patients with comorbidity was associated with higher incidences of ICU admission (p<0.02).Better patient outcomes have been noted who were on treatment with ART at the time of pneumonia and previous history of pneumococcal vaccination (p<0.01). In hospital morality was higher among patients with CAP+HIV(p<0.03) Conclusions: There were several risk factors predicting poor outcomes in patients with CAP associated with HIV infection and commonly there are modifiable through that we can improve patients outcome. Prevention of malnutrition, use of antiretroviral therapy and infection control above HIV infection, use of pneumococcal vaccination are associated with better patient outcomes in such patients.