Bai Anthony D, Srivastava Siddhartha, Martinez Cajas Jorge L, Razak Fahad, Verma Amol A
Division of Infectious Diseases, Department of Medicine, Queen's University, Kingston, Ontario, Canada.
Division of General Internal Medicine, Department of Medicine, Queen's University, Kingston, Ontario, Canada.
Clin Infect Dis. 2025 Feb 24;80(2):397-403. doi: 10.1093/cid/ciae393.
It is unclear if human immunodeficiency virus (HIV) affects the prognosis for community-acquired pneumonia (CAP) in the current era of effective antiretroviral therapy. In this multicenter retrospective cohort study of patients admitted for CAP, we compared the in-hospital mortality rate between people with HIV (PWH) and those without.
The study included consecutive patients admitted with a diagnosis of CAP across 31 hospitals in Ontario, Canada, from 2015 to 2022. HIV infection was based on discharge diagnoses and antiretroviral prescription. The primary outcome was in-hospital mortality. Competing risk models were used to describe time to death in hospital or discharge. Potential confounders were balanced using overlap weighting of propensity scores.
Of 82 822 patients admitted with CAP, 1518 (1.8%) had a diagnosis of HIV. PWH were more likely to be younger, male, and have fewer comorbidities. In the hospital, 67 (4.4%) PWH and 6873 (8.5%) people without HIV died. HIV status had an adjusted subdistribution hazard ratio of 1.02 (95% confidence interval, .80-1.31; P = .8440) for dying in the hospital. Of 1518 PWH, 440 (29.0%) patients had a diagnosis of AIDS. AIDS diagnosis had an adjusted subdistribution hazard ratio of 3.04 (95% CI, 1.69-5.45; P = .0002) for dying in the hospital compared to HIV without AIDS.
People with and without HIV admitted for CAP had a similar in-hospital mortality rate. For PWH, AIDS significantly increased the mortality risk. HIV infection by itself without AIDS should not be considered a poor prognostic factor for CAP.
在当前有效的抗逆转录病毒治疗时代，人类免疫缺陷病毒（HIV）是否会影响社区获得性肺炎（CAP）的预后尚不清楚。在这项针对因CAP入院患者的多中心回顾性队列研究中，我们比较了HIV感染者（PWH）和未感染者的院内死亡率。
该研究纳入了2015年至2022年期间在加拿大安大略省31家医院连续入院诊断为CAP的患者。HIV感染基于出院诊断和抗逆转录病毒药物处方。主要结局是院内死亡率。使用竞争风险模型描述住院死亡或出院时间。通过倾向得分的重叠加权平衡潜在混杂因素。
在82822例因CAP入院的患者中，1518例（1.8%）被诊断为HIV。PWH更可能较年轻、为男性且合并症较少。在医院中，67例（4.4%）PWH和6873例（8.5%）未感染HIV者死亡。HIV状态在院内死亡的校正亚分布风险比为1.02（95%置信区间，0.80 - 1.31；P = 0.8440）。在1518例PWH中，440例（29.0%）患者被诊断为艾滋病。与未患艾滋病的HIV感染者相比，艾滋病诊断在院内死亡的校正亚分布风险比为3.04（95%CI，1.69 - 5.45；P = 0.0002）。
因CAP入院的HIV感染者和未感染者院内死亡率相似。对于PWH，艾滋病显著增加了死亡风险。未患艾滋病的HIV感染本身不应被视为CAP的不良预后因素。
