title: Comparing clinical outcomes in HIV-infected and uninfected older men hospitalized with community-acquired pneumonia.
abstract: OBJECTIVE
  Outcomes of community-acquired pneumonia (CAP) among HIV-infected older adults are unclear.
  
  
  METHODS
  Associations between HIV infection and three CAP outcomes (30-day mortality, readmission within 30 days post-discharge, and hospital length of stay [LOS]) were examined in the Veterans Aging Cohort Study (VACS) of male Veterans, age ≥ 50 years, hospitalized for CAP from 10/1/2002 through 08/31/2010. Associations between the VACS Index and CAP outcomes were assessed in multivariable models.
  
  
  RESULTS
  Among 117 557 Veterans (36 922 HIV-infected and 80 635 uninfected), 1203 met our eligibility criteria. The 30-day mortality rate was 5.3%, the mean LOS was 7.3 days, and 13.2% were readmitted within 30 days of discharge. In unadjusted analyses, there were no significant differences between HIV-infected and uninfected participants regarding the three CAP outcomes (P > 0.2). A higher VACS Index was associated with increased 30-day mortality, readmission, and LOS in both HIV-infected and uninfected groups. Generic organ system components of the VACS Index were associated with adverse CAP outcomes; HIV-specific components were not. Among HIV-infected participants, those not on antiretroviral therapy (ART) had a higher 30-day mortality (HR 2.94 [95% CI 1.51, 5.72]; P = 0.002) and a longer LOS (slope 2.69 days [95% CI 0.65, 4.73]; P = 0.008), after accounting for VACS Index. Readmission was not associated with ART use (OR 1.12 [95% CI 0.62, 2.00] P = 0.714).
  
  
  CONCLUSIONS
  Among HIV-infected and uninfected older adults hospitalized for CAP, organ system components of the VACS Index were associated with adverse CAP outcomes. Among HIV-infected individuals, ART was associated with decreased 30-day mortality and LOS.
authors.affiliation: Infectious Disease, Yale University School of Medicine, New Haven, CT, USA.|Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: L A
authors.initials: LA
authors.lastname: Barakat
authors.affiliation: Infectious Disease, Yale University School of Medicine, New Haven, CT, USA.|Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: M
authors.initials: M
authors.lastname: Juthani-Mehta
authors.affiliation: Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: H
authors.initials: H
authors.lastname: Allore
authors.affiliation: Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: M
authors.initials: M
authors.lastname: Trentalange
authors.affiliation: Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA.
authors.forename: J
authors.initials: J
authors.lastname: Tate
authors.affiliation: Infectious Disease, VA Medical Center, Decatur, GA, USA.
authors.forename: D
authors.initials: D
authors.lastname: Rimland
authors.affiliation: Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.|Pulmonary Disease and Critical Care, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: M
authors.initials: M
authors.lastname: Pisani
authors.affiliation: Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.|Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA.|Pulmonary Disease and Critical Care, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Akgün
authors.affiliation: Infectious Disease, VA Greater Los Angles Healthcare System, Los Angelos, CA, USA.
authors.forename: M B
authors.initials: MB
authors.lastname: Goetz
authors.affiliation: Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Butt
authors.affiliation: Infectious Diseases (MS 111G), Michael E. Debakey VA Medical Center, Houston, TX, USA.
authors.forename: M
authors.initials: M
authors.lastname: Rodriguez-Barradas
authors.affiliation: Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA.
authors.forename: M
authors.initials: M
authors.lastname: Duggal
authors.affiliation: Pulmonary Disease and Critical Care, University of Washington, Seattle, WA, USA.
authors.forename: K
authors.initials: K
authors.lastname: Crothers
authors.affiliation: Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.|Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA.
authors.forename: A C
authors.initials: AC
authors.lastname: Justice
authors.affiliation: Infectious Disease, Yale University School of Medicine, New Haven, CT, USA.|Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: V J
authors.initials: VJ
authors.lastname: Quagliarello
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000276:immunology / Q000401:mortality*; D015415:Biomarkers; D017714:Community-Acquired Infections / Q000276:immunology / Q000401:mortality*; D015658:HIV Infections / Q000150:complications / Q000276:immunology / Q000401:mortality*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000209:etiology / Q000276:immunology / Q000401:mortality*; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data*
chemical_list: D015415:Biomarkers
keywords: HIV; outcomes; pneumonia