Clinical presentation among HIV-infected and non-infected adults with community acquired pneumonia in Nairobi.
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.
Mwachari
C W
CW
Centre for Respiratory Disease Research, Kenya Medical Research Institute, PO Box 47855, Nairobi, Kenya. cmwachari@kemri.org
Nduba
V N
VN
Park
D R
DR
Meier
A S
AS
Kariuki
J N
JN
Muyodi
J A
JA
Karimi
F
F
Kigo
A
A
Holmes
K K
KK
Cohen
C R
CR
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
D000900:Anti-Bacterial Agents; D004917:Erythromycin