Mortality after hospitalization for pneumonia among individuals with HIV, 1995-2008: a Danish cohort study.
BACKGROUND
HIV-infected persons are at increased risk of pneumonia, even with highly active antiretroviral treatment (HAART). We examined the impact of pneumonia on mortality and identified prognostic factors for death among HIV-infected.


RESULTS
In a nationwide, population-based cohort of individuals with HIV, we included persons hospitalized with pneumonia from the Danish National Hospital Registry and obtained mortality data from the Danish Civil Registration System. Comparing individuals with and without pneumonia, we used Poisson regression to estimate relative mortality and logistic regression to examine prognostic factors for death following pneumonia. From January 1, 1995, to July 1, 2008, we observed 699 episodes of first hospitalization for pneumonia among 4,352 HIV patients. Ninety-day mortality after pneumonia decreased from 22.4% (95% confidence interval [CI]: 16.5%-28.9%) in 1995-1996 to 8.4% (95% CI: 6.1%-11.6%) in 2000-2008. Mortality remained elevated for more than a year after hospitalization for pneumonia: adjusted mortality rate ratio 5.38 (95% CI: 4.27-6.78), 1.80 (95% CI: 1.36-2.37), and 1.62 (95% CI: 1.32-2.00) for days 0-90, 91-365, and 366+, respectively. The following variables predicted mortality within 90 days following hospitalization for pneumonia (adjusted Odds Ratios): male sex (3.77, 95% CI: 1.37-10.4), Charlson Comorbidity Index score > or = 2 (3.86, 95% CI: 2.19-6.78); no current HAART (3.58, 95% CI: 1.83-6.99); history of AIDS (2.46, 95% CI: 1.40-4.32); age per 10 year increase (1.43, 95% CI: 1.11-1.85); and CD4+ cell count < or = 200 (2.52, 95% CI: 1.37-4.65).


CONCLUSIONS
The first hospitalization for pneumonia among HIV-infected individuals was associated with elevated risk of death up to more than a year later. Use of HAART decreased the risk, independent of current CD4+ cell count. Prognosis following pneumonia improved over calendar time.
Søgaard
Ole S
OS
Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark. olesoega@rm.dk
Lohse
Nicolai
N
Gerstoft
Jan
J
Kronborg
Gitte
G
Østergaard
Lars
L
Pedersen
Court
C
Pedersen
Gitte
G
Sørensen
Henrik Toft
HT
Obel
Niels
N
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D003718:Denmark; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000401:mortality*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011014:Pneumonia / Q000150:complications* / Q000401:mortality* / Q000821:virology; D011379:Prognosis; D012042:Registries; D012044:Regression Analysis