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Observational Study
. 2015 Aug;16(7):421-30.
doi: 10.1111/hiv.12244. Epub 2015 May 11.

Comparing clinical outcomes in HIV-infected and uninfected older men hospitalized with community-acquired pneumonia

L A Barakat  1   2 , M Juthani-Mehta  1   2 , H Allore  2 , M Trentalange  2 , J Tate  3 , D Rimland  4 , M Pisani  2   5 , K M Akgün  2   3   5 , M B Goetz  6 , A A Butt  7 , M Rodriguez-Barradas  8 , M Duggal  3 , K Crothers  9 , A C Justice  2   3 , V J Quagliarello  1   2
Affiliations
Observational Study

Comparing clinical outcomes in HIV-infected and uninfected older men hospitalized with community-acquired pneumonia

L A Barakat et al. HIV Med. 2015 Aug.

Abstract

Objectives: Outcomes of community-acquired pneumonia (CAP) among HIV-infected older adults are unclear.

Methods: Associations between HIV infection and three CAP outcomes (30-day mortality, readmission within 30 days post-discharge, and hospital length of stay [LOS]) were examined in the Veterans Aging Cohort Study (VACS) of male Veterans, age ≥ 50 years, hospitalized for CAP from 10/1/2002 through 08/31/2010. Associations between the VACS Index and CAP outcomes were assessed in multivariable models.

Results: Among 117 557 Veterans (36 922 HIV-infected and 80 635 uninfected), 1203 met our eligibility criteria. The 30-day mortality rate was 5.3%, the mean LOS was 7.3 days, and 13.2% were readmitted within 30 days of discharge. In unadjusted analyses, there were no significant differences between HIV-infected and uninfected participants regarding the three CAP outcomes (P > 0.2). A higher VACS Index was associated with increased 30-day mortality, readmission, and LOS in both HIV-infected and uninfected groups. Generic organ system components of the VACS Index were associated with adverse CAP outcomes; HIV-specific components were not. Among HIV-infected participants, those not on antiretroviral therapy (ART) had a higher 30-day mortality (HR 2.94 [95% CI 1.51, 5.72]; P = 0.002) and a longer LOS (slope 2.69 days [95% CI 0.65, 4.73]; P = 0.008), after accounting for VACS Index. Readmission was not associated with ART use (OR 1.12 [95% CI 0.62, 2.00] P = 0.714).

Conclusion: Among HIV-infected and uninfected older adults hospitalized for CAP, organ system components of the VACS Index were associated with adverse CAP outcomes. Among HIV-infected individuals, ART was associated with decreased 30-day mortality and LOS.

Keywords: HIV; outcomes; pneumonia.

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Figures

Fig. 1
Fig. 1
The Veterans Aging Cohort Study (VACS) community-acquired pneumonia (CAP) cohort. *Race, smoking status, pulmonary comorbidity, alcohol-related and drug-related diagnoses within the year prior to admission and VACS Index score.
Fig. 2
Fig. 2
Adjusted 30-day mortality rate by Veterans Aging Cohort Study (VACS) Index and antiretroviral therapy (ART). *Deaths/1000 person-months and 95% confidence interval, adjusted for race, smoking status, pulmonary comorbidity, and alcohol-related and drug-related diagnoses within the year prior to admission.
See this image and copyright information in PMC

References

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