The study aimed to investigate whether the clinical presentations and outcomes (length-of-stay (LOS), intensive care unit (ICU) admission and 30-day mortality) of pneumococcal pneumonia in virologically suppressed HIV-infected patients on ART with a CD4+ T cell count >350 cells/mm3 are comparable to those seen in non-HIV-infected patients, using a case-control design.
A case-control study was carried out in Hospital Clinic, Barcelona, Spain (2001-2016). Controls were matched by age (±10 years), gender, co-morbidities and pneumonia diagnosis in the same calendar period. Clinical presentation and outcomes of pneumococcal pneumonia in HIV-infected patients and non-HIV-infected patients were compared.
Pneumococcal pneumonia was studied in 50 cases (HIV-infection) and 100 controls (non-HIV-infection). Compared with the control patients, case patients had higher rates of influenza (14% vs. 2%, p=0·007) and pneumococcal vaccination (10% vs. 1%, p=0·016). The group of cases also presented a higher rate of co-infection with HBV (6% vs. 0%, p=0·036). Both groups presented similar ICU admission (18% vs. 27%, p=0·22), need for mechanical ventilation (12% vs. 8%; p=0·43), length of stay (7 days vs. 7 days, p<0·76) and 0% of 30-day mortality. No evidence was found of a more severe presentation or a worse clinical outcome in cases than in controls.
Pneumococcal pneumonia episodes requiring hospitalization in virologically suppressed HIV-infected patients with >350 CD4+ T cell count/mm3 were neither more severe nor had worse prognosis compared with uninfected patients. These results support the fact that such patients do not need treatment, admission or care sites different to the general population.