Department of Medicine, Section of Infectious Diseases, Providence Hospital, 1150 Varnum street, NE, Washington, DC 20017, USA.
Int J Infect Dis. 2011 Dec;15(12):e822-7. doi: 10.1016/j.ijid.2011.05.021. Epub 2011 Aug 31.
Outcomes of community-acquired pneumonia (CAP) in relation to CD4+ cell counts have not been established. We examined the correlation of CD4+ cell count and HIV-RNA level with the clinical outcomes of CAP in hospitalized HIV-infected patients.
This was a retrospective study of 127 adult hospitalized patients with HIV infection enrolled with the CAP Organization (CAPO), examining the time to clinical stability (TCS), length of hospital stay (LOS), and all-cause mortality.
Mortality data were available for 117 HIV-infected patients with CAP. Death within 28 days was reported in 28 patients. The risk of mortality at 28 days was not significant when adjusted for CD4+ cell count (p=0.123), HIV-RNA <400-1000 copies/ml (p=0.093), HIV-RNA ≥ 1000-10,000 copies/ml (p=0.543), and HIV-RNA ≥ 10,000-100,000 copies/ml (p=0.383). The propensity-adjusted Cox proportional hazards regression models did not show any statistically significant differences in LOS or TCS for CD4+ cell counts (p=0.590 and p=0.420, respectively) or HIV-RNA levels (p=0.470 and p=0.080, respectively). Multivariable Cox proportional hazards models did not reveal any statistically significant relationships between CD4+ cell counts or HIV-RNA levels with LOS or TCS.
Our study shows that clinical outcomes of HIV-infected patients with CAP are not predicted by CD4+ cell counts or HIV-RNA levels after adjusting for confounders. The management of CAP in patients with HIV infection should not be based on CD4+ cell counts or HIV-RNA levels of the HIV infection.
社区获得性肺炎（CAP）与 CD4+ 细胞计数的结果尚未确定。我们研究了 CD4+ 细胞计数和 HIV-RNA 水平与住院 HIV 感染患者 CAP 临床结果的相关性。
这是一项对 127 名成年住院 HIV 感染患者进行的回顾性研究，他们参与了 CAP 组织（CAPO），检查临床稳定时间（TCS）、住院时间（LOS）和全因死亡率。
117 名 HIV 感染 CAP 患者的死亡率数据可用。28 天内报告了 28 例死亡。在调整 CD4+ 细胞计数（p=0.123）、HIV-RNA<400-1000 拷贝/ml（p=0.093）、HIV-RNA≥1000-10000 拷贝/ml（p=0.543）和 HIV-RNA≥10000-100000 拷贝/ml（p=0.383）后，死亡风险在 28 天内无显著差异。倾向评分调整的 Cox 比例风险回归模型显示，CD4+ 细胞计数（p=0.590 和 p=0.420）或 HIV-RNA 水平（p=0.470 和 p=0.080）与 LOS 或 TCS 无统计学显著差异。多变量 Cox 比例风险模型也未显示 CD4+ 细胞计数或 HIV-RNA 水平与 LOS 或 TCS 之间存在任何统计学显著关系。
我们的研究表明，在调整混杂因素后，CD4+ 细胞计数或 HIV-RNA 水平不能预测 HIV 感染 CAP 患者的临床结果。HIV 感染患者 CAP 的管理不应基于 CD4+ 细胞计数或 HIV-RNA 水平。
