title: Bacteraemic pneumococcal pneumonia: impact of HIV on clinical presentation and outcome.
abstract: OBJECTIVE
  The objectives of this study were to investigate the clinical and laboratory features, hospital course and outcome of patients with bacteraemic pneumococcal pneumonia, comparing HIV with non-HIV patients, as well as HIV patients from different parts of the world.
  
  
  METHODS
  This was a multicentre prospective observational study of consecutive adult cases with bacteraemic pneumococcal pneumonia in 10 countries on 6 continents.
  
  
  RESULTS
  A total of 768 cases were recruited, of which 200 were HIV-infected; 166 were from South Africa. Lower age, i.v. drug use, fewer co-morbid illnesses, and a higher frequency of respiratory symptoms were significantly more likely to occur in HIV patients. The 14-day mortality for the group as a whole was 14.5%, being 16% in the HIV patients and 13.9% in the non-HIV patients (not significant). When adjustments were made for age and severity of illness, HIV patients had significantly higher 14-day mortality with significant trend for increasing 14-day mortality in those with lower CD4 counts. Despite differences in various clinical and laboratory parameters in patients from different parts of the world, on multivariate analysis, when adjusting for regional differences, the HIV-infected patients were still noted to have poorer 14-day mortality.
  
  
  CONCLUSIONS
  This study, in contrast to previous investigations, indicates that there are significant differences in the clinical presentation and outcome of bacteraemic pneumococcal pneumonia when comparing HIV and non-HIV patients.
authors.affiliation: Division of Pulmonology, Department of Medicine, Johannesburg Hospital, University of the Witwatersrand, Medical School, 7 York Road, Parktown 2193, Johannesburg, South Africa. feldmanc@medicine.wits.ac.za
authors.forename: Charles
authors.initials: C
authors.lastname: Feldman
authors.forename: Keith P
authors.initials: KP
authors.lastname: Klugman
authors.forename: Victor L
authors.initials: VL
authors.lastname: Yu
authors.forename: Ake
authors.initials: A
authors.lastname: Ortqvist
authors.forename: Christine C C
authors.initials: CC
authors.lastname: Choiu
authors.forename: Maria Bernadete F
authors.initials: MB
authors.lastname: Chedid
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
authors.forename: Marilyn
authors.initials: M
authors.lastname: Wagener
mesh_terms: D000328:Adult; D017714:Community-Acquired Infections / Q000503:physiopathology; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011018:Pneumonia, Pneumococcal / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome