title: CD4+ cell counts and HIV-RNA levels do not predict outcomes of community-acquired pneumonia in hospitalized HIV-infected patients.
abstract: BACKGROUND
  Outcomes of community-acquired pneumonia (CAP) in relation to CD4+ cell counts have not been established. We examined the correlation of CD4+ cell count and HIV-RNA level with the clinical outcomes of CAP in hospitalized HIV-infected patients.
  
  
  METHODS
  This was a retrospective study of 127 adult hospitalized patients with HIV infection enrolled with the CAP Organization (CAPO), examining the time to clinical stability (TCS), length of hospital stay (LOS), and all-cause mortality.
  
  
  RESULTS
  Mortality data were available for 117 HIV-infected patients with CAP. Death within 28 days was reported in 28 patients. The risk of mortality at 28 days was not significant when adjusted for CD4+ cell count (p=0.123), HIV-RNA <400-1000 copies/ml (p=0.093), HIV-RNA ≥ 1000-10,000 copies/ml (p=0.543), and HIV-RNA ≥ 10,000-100,000 copies/ml (p=0.383). The propensity-adjusted Cox proportional hazards regression models did not show any statistically significant differences in LOS or TCS for CD4+ cell counts (p=0.590 and p=0.420, respectively) or HIV-RNA levels (p=0.470 and p=0.080, respectively). Multivariable Cox proportional hazards models did not reveal any statistically significant relationships between CD4+ cell counts or HIV-RNA levels with LOS or TCS.
  
  
  CONCLUSIONS
  Our study shows that clinical outcomes of HIV-infected patients with CAP are not predicted by CD4+ cell counts or HIV-RNA levels after adjusting for confounders. The management of CAP in patients with HIV infection should not be based on CD4+ cell counts or HIV-RNA levels of the HIV infection.
authors: Department of Medicine, Section of Infectious Diseases, Providence Hospital, 1150 Varnum street, NE, Washington, DC 20017, USA. jbordon@provhosp.org
authors: Jose
authors: J
authors: Bordon
authors: Rama
authors: R
authors: Kapoor
authors: Cesar
authors: C
authors: Martinez
authors: Daniel
authors: D
authors: Portela
authors: Padmaraj
authors: P
authors: Duvvuri
authors: Alyona
authors: A
authors: Klochko
authors: Kwabena
authors: K
authors: Ayesu
authors: Paula
authors: P
authors: Peyrani
authors: Catia
authors: C
authors: Cillóniz
authors: Timothy
authors: T
authors: Wiemken
authors: Ana
authors: A
authors: Parra
authors: Antoni
authors: A
authors: Torres
authors: Jordi
authors: J
authors: Rello
authors: Julio
authors: J
authors: Ramirez
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000150:complications / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology / Q000401:mortality; D015497:HIV-1 / Q000235:genetics*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D018410:Pneumonia, Bacterial / Q000150:complications / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D011379:Prognosis; D016016:Proportional Hazards Models; D012367:RNA, Viral / Q000097:blood*; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
chemical_list: D012367:RNA, Viral