title: Mortality after hospitalization for pneumonia among individuals with HIV, 1995-2008: a Danish cohort study.
abstract: 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.
authors.affiliation: Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark. olesoega@rm.dk
authors.forename: Ole S
authors.initials: OS
authors.lastname: Søgaard
authors.forename: Nicolai
authors.initials: N
authors.lastname: Lohse
authors.forename: Jan
authors.initials: J
authors.lastname: Gerstoft
authors.forename: Gitte
authors.initials: G
authors.lastname: Kronborg
authors.forename: Lars
authors.initials: L
authors.lastname: Østergaard
authors.forename: Court
authors.initials: C
authors.lastname: Pedersen
authors.forename: Gitte
authors.initials: G
authors.lastname: Pedersen
authors.forename: Henrik Toft
authors.initials: HT
authors.lastname: Sørensen
authors.forename: Niels
authors.initials: N
authors.lastname: Obel
mesh_terms: 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