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Original Research |

Community-Acquired Pneumococcal Pneumonia in Virologically Suppressed HIV-Infected Adult Patients: A Matched Case-Control Study

Catia Cillóniz, PhD; Antoni Torres, MD; Christian Manzardo, MD; Albert Gabarrús, MSc; Juan Ambrosioni, MD; Adriana Salazar, MD; Felipe García, MD; Adrián Ceccato, MD; Josep Mensa, MD; Jorge Puig de la Bella Casa, MD; Asunción Moreno, MD; Jose M. Miró, MD
Author and Funding Information

Funding: Funded by CIBERES (CibeRes CB06/06/0028).

Conflicts of interest: We declare no conflicts of interest.

1Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB) - SGR 911- Ciber de Enfermedades Respiratorias (Ciberes) Barcelona, Spain

2Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain

3Infectología de Adultos, Hospital General Regional nº1, Instituto Mexicano del Seguro Social, Tijuana, BC, Mexico

4Seccion Neumología, Hospital Nacional Alejandro Posadas, Palomar, Argentina

5Department of Microbiology, Hospital Clinic of Barcelona Spain

Corresponding author: Professor Antoni Torres Department of Pneumology, Hospital Clinic of Barcelona C/ Villarroel 170, 08036 Barcelona, Spain.


Copyright 2017, . All Rights Reserved.


Chest. 2017. doi:10.1016/j.chest.2017.03.007
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Abstract

Background  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.

Methods  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.

Results  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.

Conclusions  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.


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