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, 4 (9), e7022

Mortality After Hospitalization for Pneumonia Among Individuals With HIV, 1995-2008: A Danish Cohort Study

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Mortality After Hospitalization for Pneumonia Among Individuals With HIV, 1995-2008: A Danish Cohort Study

Ole S Søgaard et al. PLoS One.

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.

Methodology/principal findings: 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/significance: 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.

Conflict of interest statement

Competing Interests: Niels Obel has received research funding from Roche, Bristol-Myers Squibb, Merck Sharp & Dohme, GlaxoSmithKline, Abbott, Boehringer Ingelheim, Janssen-Cilag and Swedish Orphan. Jan Gerstoft has received research funding from Abbott, Roche, Bristol-Myers Squibb, Merk Sharp & Dohme, Pharmasia, GlaxoSmithKline, Swedish Orphan and Boehringer Ingelheim. Ole S. Søgaard, Nicolai Lohse, Gitte Kronborg, Lars Østergaard, Court Pedersen, Gitte Pedersen, Henrik Toft Sørensen have reported no conflicts of interest.

Figures

Figure 1
Figure 1. Mortality after first hospitalization for pneumonia among persons with HIV by time period.

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