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

Volume 8, Issue 4, August 2023     |     PP. 252-264      |     PDF (295 K)    |     Pub. Date: August 8, 2023
DOI: 10.54647/cm321137    87 Downloads     2689 Views  

Author(s)

Alizamin Sadigov, Pulmonary and Critical Care Medicine Department, Therapeutic and Education Clinic, Medical University of Azerbaijan, Baku. Azerbaijan
Rauf Baylarov, Pulmonary and Critical Care Medicine Department, Therapeutic and Education Clinic, Medical University of Azerbaijan, Baku. Azerbaijan
Malahat Sultanova, Pulmonary and Critical Care Medicine Department, Therapeutic and Education Clinic, Medical University of Azerbaijan, Baku. Azerbaijan

Abstract
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.

Keywords
HIV infection, community acquired pneumonia, risk factors , ICU admission, poor outcomes, mortality

Cite this paper
Alizamin Sadigov, Rauf Baylarov, Malahat Sultanova, Predicting of Poor Outcomes for Patients HIV-associated Community-Acquired Pneumonia: Who are at risk and how reduce mortality in such patients? , SCIREA Journal of Clinical Medicine. Volume 8, Issue 4, August 2023 | PP. 252-264. 10.54647/cm321137

References

[ 1 ] Rurshtivk RE.Glassroth J.Jordan MC,et al bacterial pneumonia in persons infected with the human immundeficiency virus.Pulmonary complications of HIV infection study group N Engl.J. Med. 1995:333(13); 845-851 Available at: https:www. Ncbi.nlm.nih./pubmed/ 7651475,
[ 2 ] Sogaard OS,Lohse N,Gerstoft J Hospitalization of pneumonia among individuals with and without HIV infection.1995-2007 : a Densh population based nationwide cohort study. Clinfert D 13.2008; 47(10) 1345-1353. Available at:htpps:// www.ncbi.nlm.nih.gov/pubmed/ 18834317
[ 3 ] Aston SJ HoA,Jary H,etal Aetology and risk factors for mortality in an adult community acquired pneumonia cohort in Malawi,An Respir Crit Care Med.2019.Available at:https:wnn.ncbi.nlm.nih.gov (pubmed) 30625278
[ 4 ] Jambo KC,Banda DH,Kan Kwatira,AM,etal.Small alveolar macrophages are infected preferentially by HIV and exhibit impared phagocytis function.Mucosal Immunol.2024;7(5):1116-1126.Avialableat:https:wnn.ncbi.nlm.nih.gov pubmed 24472847
[ 5 ] Charles TP, Shelito J ,Human immunodeficiency virus infection and host defence in the lungs .Semein Respir Crit Care Med 2016;37(2):
[ 6 ] Gordin FM, Roediger MP, PM Girard et al. Pneumonia in HIV-infected persons: increased risk with cigarette smoking and treatment interruption. Am J Respir Crit Care Med.2008 ; 178 (6): 630-636.
[ 7 ] Lamas CC, Coelho LE, Grinsztejn BJ, Veloso VG. Community-acquired lower respiratory tract infections in HIV-infected patients on antiretroviral therapy: predictors in a contemporary cohort. Infection. 2017;45(6):801-809.
[ 8 ] Edelman ES, Gordon KS, Crothers K, et al. Association of Prescribed Opioids With Increased Risk of Community-Acquired Pneumonia Among Patients With and Without HIV. JAMA Intern Med. 2019;179(3):297-304.
[ 9 ] Burack JH, Hohn JA, Saint-Maurice D, Jacobson MA. Microbiology of community-acquired bacterial pneumonia in persons with and at risk for human immunodeficiency virus type 1 infection. Implications for rational empiric antibiotic therapy. Arch Intern Med. 1994; 154(22): 2589-2596.
[ 10 ] Müller RF, Foley NM, Kessel D, Jeffrey AA. Community-acquired lobar pneumonia in patients with HIV infection and AIDS. Thorax.1994; 49(4): 367-368
[ 11 ] Mundy LM, Auwaerter PG, Oldach D, et al. Community-acquired pneumonia: impact of immune status. Am J Respir Crit Care Med. 1995 ; 152(4 Pt1): 1409-1315.
[ 12 ] Rimland D, Navin TR, Lennox JL, et al. Prospective study of etiologic agents of community-acquired pneumonia in patients with HIV infection. AIDS. 2002; 16 (1): 85-95.
[ 13 ] Afessa B, Green B. Bacterial pneumonia in hospitalized patients with HIV infection: the Pulmonary Complications, ICU Support, and Prognostic Factors of Hospitalized Patients with HIV (PIP) Study. Chest 2000; 117-1022
[ 14 ] Attia EF, McGinns KA, Feemster LC, et al. Association of COPD with risk for pulmonary infections requiring hospitalization in HIV infected veterans. J Acquir Immune Defic Syndrom 2015; 70(3): 280-288.
[ 15 ] Muccini C, Galli L, Lepri AC, et al. Incidence, timing, and determinants of bacterial pneumonia among HIV- infected patients: data from the ICONA Foundation cohort. J Acquir Immune Defic Syndr. 20B; 63 (3): 339-345.
[ 16 ] Bordon JM, Fernandez-Bortan R, Wiemken TL, et al. Bacteremic pneumococcal pneumonia: clinical outcomes and preliminary results of inflammatory response. Infection. 2015; 43(6): 729-738.
[ 17 ] Zolopa A, Anderson J, Powderly W et al. Early antiretroviral therapy reduces AIDS progression/death in individuals with acute opportunistic infections: a multicenter randomized strategy trial. PLoS One. 2009; 4(5): e55 75.
[ 18 ] O’Connor J, Vjecka MJ, Philips AN, at al. Effect of immediate initiation of antiretroviral therapy on risk of severe bacterial infections in HIV-positive people with CD4 cell counts of more than 500 cells per μL: secondary outcome results from a randomised controlled trial. Lancet HIV 2017; 4(3): e105- e112.
[ 19 ] Sullivan JH, Moore RD, Keruly JC, Chaisson RE. Effect of antiretroviral therapy on the incidence of bacterial pneumonia in patients with advanced HIV infection. Am J Respir Crit Care Med 2000; 162(1): 64-67.
[ 20 ] Cilloniz C, Torres A, Manzardo C, et al. Community-acquired pneumococcal pneumonia in virologically supressed HIV-infected adult patients: a matched case control study. Chest. 2017; 152 (2): 295-303.