Recurrent pneumonia mortality risk in a HIV/AIDS Puerto Rican cohort.
Recurrent pneumonia (RP) within 12 months is one of the AIDS diagnosis criteria. To gain knowledge of RP infection in HIV-infected patients, we studied 145 RP cases detected in a cohort of 2,996 HIV patients in Puerto Rico between Jan. 1992-Dec. 2001. The RP prevalence was 4.8%; 77.2% were males and 62.1% were injecting drug users (IDU). At the time of RP diagnosis, the mean CD4+ T cell count was 93.8 cells/mm3, 59.3% were in antiretroviral treatment, 13% had received the pneumococcal vaccine and 84.8% had another AIDS related condition. Over 37% received two or more antiretroviral medications. The death rate in the first year after the RP diagnosis was 63.4%. A Cox proportional hazard analysis showed that CD4+ T cells <200/mm3 (p<0.05), history of toxoplasmosis (p<0.01), wasting syndrome (p<0.01), esophageal candidiasis (p<0.05) and lower number of antiretroviral medications (p<0.05) increased their mortality risk. The studied patients had a highly compromised immune system and a very low pneumococcal vaccination percent at the time of RP diagnosis. Low CD4+ T cells significantly increased the hazard and mortality risk of the cases studied. Antecedents of antiretroviral therapy in these patients ensure a better outcome with lower mortality. Efforts to increase the vaccination rate should reduce the RP incidence in our HIV-infected population.
Retrovirus Research Center, Universidad Central del Caribe, School of Medicine, Bayamón, Puerto Rico, USA. amayorb@hotmail.com
A M
AM
Mayor
M A
MA
Gomez
E
E
Rios
R F
RF
Hunter
D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D022242:Pneumococcal Vaccines / Q000627:therapeutic use; D011014:Pneumonia / Q000209:etiology* / Q000401:mortality* / Q000517:prevention & control; D015995:Prevalence; D011647:Puerto Rico / Q000453:epidemiology; D012008:Recurrence; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000150:complications
D044966:Anti-Retroviral Agents; D022242:Pneumococcal Vaccines