title: Changes in the etiology, incidence and prognosis of acute lower respiratory track infections in human immunodeficiency virus patients.
abstract: OBJECTIVE
  To describe the incidence, the changes in the etiology and the prognosis of lower respiratory tract infection (LRTI) in HIV infected patients, presenting by the first time to the Emergency Department (ED), during years 2000-2010.
  
  
  METHODS
  Prospective collection of data.
  
  
  METHODS
  Data were collected on the first visit of HIV-infected patients at our ED due to a LRTI, (defined according to the criteria of the European Respiratory Society), between 1/1/2000 and 31/12/2010. A series of epidemiological and laboratory variables as well as the need for admission to the intensive care unit (ICU). LRTI etiology were also collected. The influence ofthe mentioned variables on 30-day mortality were analyzed.
  
  
  RESULTS
  One hundred thirty one patients were included. LRTI represented 27% of visits to the ED by HIV-infected patients. Mean age was 39±9 years. 72% of patients were males. 18% required admission to the ICU. The most frequent LRTI was pneumonia by P. jiroveci in 35 cases, bacterial penumonia in 27 and pulmonary tuberculosis in 20. LRTI incidence gradually reduced significantly over time from 6.13 × 1000 patients/year in year 2000 to 0.23 × 1000 patients/year in 2010 (p<0.05). Overall mortality was 14%. Logistic regression analysis showed that admission to ICU (p<0.004) and viral load (p<0.029) were independent variables predicting mortality.
  
  
  CONCLUSIONS
  LRTI is a pathology with a decreasing incidence, probably related to the widespread utilization increased of HAART regimens. lts etiology has also been changing, but with a non negligible mortality, mostly when ICU admission was required.
authors.affiliation: Emergency Department, Hospital Clínic, "Emergency Care: Processes and Pathologies" Research Group, IDIBAPS, Barcelona, Spain. Electronic address: rperello@clinic.ub.es.
authors.forename: Rafael
authors.initials: R
authors.lastname: Perelló
authors.affiliation: Emergency Department, Hospital Clínic, "Emergency Care: Processes and Pathologies" Research Group, IDIBAPS, Barcelona, Spain.
authors.forename: Ona
authors.initials: O
authors.lastname: Escoda
authors.affiliation: Emergency Department, Hospital Clínic, "Emergency Care: Processes and Pathologies" Research Group, IDIBAPS, Barcelona, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Camón
authors.affiliation: Emergency Department, Hospital Clínic, "Emergency Care: Processes and Pathologies" Research Group, IDIBAPS, Barcelona, Spain.
authors.forename: Òscar
authors.initials: Ò
authors.lastname: Miró
authors.affiliation: Emergency Department, Hospital Clínic, "Emergency Care: Processes and Pathologies" Research Group, IDIBAPS, Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Castañeda
authors.affiliation: Department of Infectious Diseases, Hospital Clínic, IDIBAPS, University of Barcelona, Spain.
authors.forename: Asunción
authors.initials: A
authors.lastname: Moreno
authors.affiliation: Department of Microbiology, Hospital Clínic, Barcelona Centre for International Health Research (CRESIB, Hospital Clínic - University of Barcelona), Spain.
authors.forename: Maria Ángeles
authors.initials: MÁ
authors.lastname: Marcos
authors.affiliation: Emergency Department, Hospital Clínic, "Emergency Care: Processes and Pathologies" Research Group, IDIBAPS, Barcelona, Spain.
authors.forename: Verónica
authors.initials: V
authors.lastname: Perea
authors.affiliation: Emergency Department, Hospital Clínic, "Emergency Care: Processes and Pathologies" Research Group, IDIBAPS, Barcelona, Spain.
authors.forename: Natalia
authors.initials: N
authors.lastname: Alcolea
authors.affiliation: Emergency Department, Hospital Clínic, "Emergency Care: Processes and Pathologies" Research Group, IDIBAPS, Barcelona, Spain.
authors.forename: Miquel
authors.initials: M
authors.lastname: Sánchez
authors.affiliation: Department of Infectious Diseases, Hospital Clínic, IDIBAPS, University of Barcelona, Spain.
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Gatell
authors.affiliation: Department of Infectious Diseases, Hospital Clínic, IDIBAPS, University of Barcelona, Spain.
authors.forename: Esteban
authors.initials: E
authors.lastname: Martínez
mesh_terms: D000328:Adult; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011014:Pneumonia / Q000453:epidemiology*; D018410:Pneumonia, Bacterial / Q000453:epidemiology; D011020:Pneumonia, Pneumocystis / Q000453:epidemiology; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology; D019562:Viral Load; D055815:Young Adult
keywords: Emergency department; Human immunodeficiency virus; Neumonía; P. jirovecii; Pneumonia; Servicio de Urgencias; Virus de la inmunodeficiencia humana