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

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Zeitschriftentitel: HIV Medicine
Personen und Körperschaften: Barakat, LA, Juthani‐Mehta, M, Allore, H, Trentalange, M, Tate, J, Rimland, D, Pisani, M, Akgün, KM, Goetz, MB, Butt, AA, Rodriguez‐Barradas, M, Duggal, M, Crothers, K, Justice, AC, Quagliarello, VJ
In: HIV Medicine, 16, 2015, 7, S. 421-430
Format: E-Article
Sprache: Englisch
veröffentlicht:
Wiley
Schlagwörter:
Pharmacology (medical)
Infectious Diseases
Health Policy
Details
Zusammenfassung: <jats:sec><jats:title>Objectives</jats:title><jats:p>Outcomes of community–acquired pneumonia (<jats:styled-content style="fixed-case">CAP</jats:styled-content>) among <jats:styled-content style="fixed-case">HIV</jats:styled-content>‐infected older adults are unclear.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Associations between <jats:styled-content style="fixed-case">HIV</jats:styled-content> infection and three <jats:styled-content style="fixed-case">CAP</jats:styled-content> outcomes (30‐day mortality, readmission within 30 days post‐discharge, and hospital length of stay [<jats:styled-content style="fixed-case">LOS</jats:styled-content>]) were examined in the <jats:styled-content style="fixed-case">V</jats:styled-content>eterans <jats:styled-content style="fixed-case">A</jats:styled-content>ging <jats:styled-content style="fixed-case">C</jats:styled-content>ohort <jats:styled-content style="fixed-case">S</jats:styled-content>tudy (<jats:styled-content style="fixed-case">VACS</jats:styled-content>) of male Veterans, age ≥ 50 years, hospitalized for <jats:styled-content style="fixed-case">CAP</jats:styled-content> from 10/1/2002 through 08/31/2010. Associations between the <jats:styled-content style="fixed-case">VACS</jats:styled-content> Index and <jats:styled-content style="fixed-case">CAP</jats:styled-content> outcomes were assessed in multivariable models.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Among 117 557 <jats:styled-content style="fixed-case">V</jats:styled-content>eterans (36 922 <jats:styled-content style="fixed-case">HIV</jats:styled-content>‐infected and 80 635 uninfected), 1203 met our eligibility criteria. The 30‐day mortality rate was 5.3%, the mean <jats:styled-content style="fixed-case">LOS</jats:styled-content> was 7.3 days, and 13.2% were readmitted within 30 days of discharge. In unadjusted analyses, there were no significant differences between <jats:styled-content style="fixed-case">HIV</jats:styled-content>‐infected and uninfected participants regarding the three <jats:styled-content style="fixed-case">CAP</jats:styled-content> outcomes (<jats:italic>P</jats:italic> &gt; 0.2). A higher <jats:styled-content style="fixed-case">VACS</jats:styled-content> Index was associated with increased 30‐day mortality, readmission, and <jats:styled-content style="fixed-case">LOS</jats:styled-content> in both <jats:styled-content style="fixed-case">HIV</jats:styled-content>‐infected and uninfected groups. Generic organ system components of the <jats:styled-content style="fixed-case">VACS</jats:styled-content> Index were associated with adverse <jats:styled-content style="fixed-case">CAP</jats:styled-content> outcomes; <jats:styled-content style="fixed-case">HIV</jats:styled-content>‐specific components were not. Among <jats:styled-content style="fixed-case">HIV</jats:styled-content>‐infected participants, those not on antiretroviral therapy (<jats:styled-content style="fixed-case">ART</jats:styled-content>) had a higher 30‐day mortality (<jats:styled-content style="fixed-case">HR</jats:styled-content> 2.94 [95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 1.51, 5.72]; <jats:italic>P</jats:italic> = 0.002) and a longer <jats:styled-content style="fixed-case">LOS</jats:styled-content> (slope 2.69 days [95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 0.65, 4.73]; <jats:italic>P</jats:italic> = 0.008), after accounting for <jats:styled-content style="fixed-case">VACS</jats:styled-content> Index. Readmission was not associated with <jats:styled-content style="fixed-case">ART</jats:styled-content> use (<jats:styled-content style="fixed-case">OR</jats:styled-content> 1.12 [95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 0.62, 2.00] <jats:italic>P</jats:italic> = 0.714).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Among <jats:styled-content style="fixed-case">HIV</jats:styled-content>‐infected and uninfected older adults hospitalized for <jats:styled-content style="fixed-case">CAP</jats:styled-content>, organ system components of the <jats:styled-content style="fixed-case">VACS</jats:styled-content> Index were associated with adverse <jats:styled-content style="fixed-case">CAP</jats:styled-content> outcomes. Among <jats:styled-content style="fixed-case">HIV</jats:styled-content>‐infected individuals, <jats:styled-content style="fixed-case">ART</jats:styled-content> was associated with decreased 30‐day mortality and <jats:styled-content style="fixed-case">LOS</jats:styled-content>.</jats:p></jats:sec>
Umfang: 421-430
ISSN: 1464-2662
1468-1293
DOI: 10.1111/hiv.12244