AEGiS-14IAC: Severe pulmonary infections in HIV-positive patients in the HAART era.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Severe pulmonary infections in HIV-positive patients in the HAART era.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. B10235)

Narciso P, Tozzi V, Antinori A, Bellagamba R, Topino S, Sampaolesi A, Lorenzini P, Ghirga P, Antonucci F, Petrosillo N, Girardi E, Navarra A, Alba L, Palmieri F, Usro R, Ippolito G
INMI L Spallanzani, Rome, Italy

BACKGROUND: To analyze the characteristics of severe pulmonary infections. To evaluate physician's adherence to a diagnostic algorithm, approved during an internal Consensus Conference in 1999.

METHODS: All HIV-infected subjects admitted to our clinic for acute respiratory symptoms between January 2000 and June 2001 were included. Clinical characteristics, and the use of diagnostic procedures, were correlated with clinical and microbiological evidences of P. carinii pneumonia (PCP), pulmonary tuberculosis (PTB), bacterial pneumonia (BP), pulmonary non-tuberculous mycobacterial infection (PNTBM).

RESULTS: 350 subjects, 153 of whom on HAART, were evaluated. Clinical or microbiological diagnosis were: PCP (20.6%), BP (59.1%), PTB (15.4%), PNTBM (4.9%). Risk factors for PCP were: purulent sputum (p .001; OR 0.33), dyspnea (p<.0001, OR 7.98), chest pain (p < .037; OR 0.44), being HAART naïve (p< .0001; OR 4.78). Risk factors for BP were: fever > 38?C (p< .0001; OR 3.34), dyspnea (p .002; OR 0.49), chest pain (p .001; OR 2.72), asthenia (p .004; OR 0.5), being HAART naïve (p<.0001; OR 0.27). Risk factors for PTB were: fever >38?C (p<.0001; OR 0.22), dyspnea (p .001; OR 0.3), asthenia (p .016; OR 2.1). Risk factors for PNTBM were: cough (p .001; OR 0.17). Mean CD4 cell count was lower in patients with PCP (76/uL; p<.0001) and PNTBM (74/uL; p<.0001) and higher in patients with BP (216/uL; p<.0001). Mean plasma viremia was higher in patients with PTB (4.73 log cp/mL; p .027). Physician's adherence to the diagnostic algorithm was higher in patients with PCP (mean adherence score 77.2%; p<.0001) and lower in patients with PTB (mean adherence score 40.0%; p < .0001).

CONCLUSIONS: Risk assessments could provide important information for the management of patients in clinical practice. Physician's adherence to diagnostic algorithms was higher in patients with PCP and lower in patients with TB and suggesting a more complex diagnostic scenario in the latter condition.

Keywords: AEGIS, Antiretroviral Therapy, Highly Active, HIV Infections, CD4 Lymphocyte Count, Risk Factors, Tuberculosis, Pulmonary, HIV Seropositivity, Pneumonia, Pneumonia, Bacterial, Human

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