title: Clinical presentation among HIV-infected and non-infected adults with community acquired pneumonia in Nairobi.
abstract: METHODS
  Risk factors for mortality in hospitalized patients with community-acquired pneumonia (CAP) are well known. There are limited data on prognostic indicators among out-patients.
  
  
  OBJECTIVE
  To compare the clinical presentation, outcome and prognostic factors for clinical improvement in human immunodeficiency virus (HIV) infected and non-HIV-infected out-patients with CAP.
  
  
  METHODS
  Adults in Nairobi with CAP were treated with erythromycin as first-line therapy. Clinical symptoms were evaluated using a validated CAP-related symptom score (CSS). Clinical improvement was defined as reduction of baseline CSS by > or = 50%.
  
  
  RESULTS
  Of 531 adults enrolled with CAP, 422 (79.5%) completed follow-up. Participants had a mean age (+/- SD) of 33.7 +/- 11.4 years, 274 (51.6%) were male and 193 (37%) were HIV-seropositive with a higher baseline CSS (27 vs. 25, P < 0.006). Overall, 196 of 422 (46%) had clinical improvement by 28 days. Factors independently associated with a longer time to clinical improvement included not being married (adjusted hazard ratio [aHR] 0.66, 95% CI 0.48-0.92) and higher baseline CSS (aHR 1.05, 95% CI 1.03-1.06).
  
  
  CONCLUSIONS
  HIV-infected and non-infected patients with CAP responded similarly to out-patient treatment, but HIV-infected patients were more likely to present with severe symptoms. Baseline CSS and marital status were predictive of time to clinical improvement.
authors.affiliation: Centre for Respiratory Disease Research, Kenya Medical Research Institute, PO Box 47855, Nairobi, Kenya. cmwachari@kemri.org
authors.forename: C W
authors.initials: CW
authors.lastname: Mwachari
authors.forename: V N
authors.initials: VN
authors.lastname: Nduba
authors.forename: D R
authors.initials: DR
authors.lastname: Park
authors.forename: A S
authors.initials: AS
authors.lastname: Meier
authors.forename: J N
authors.initials: JN
authors.lastname: Kariuki
authors.forename: J A
authors.initials: JA
authors.lastname: Muyodi
authors.forename: F
authors.initials: F
authors.lastname: Karimi
authors.forename: A
authors.initials: A
authors.lastname: Kigo
authors.forename: K K
authors.initials: KK
authors.lastname: Holmes
authors.forename: C R
authors.initials: CR
authors.lastname: Cohen
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D017714:Community-Acquired Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D004917:Erythromycin / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D011014:Pneumonia / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D004917:Erythromycin