Association between Highly Active Antiretroviral Therapy and Type of Infectious Respiratory Disease and All-Cause In-Hospital Mortality in Patients with HIV/AIDS: A Case Series
Authors: Renata Báez-Saldaña, Adriana Villafuerte-García, Pablo Cruz-Hervert, Guadalupe Delgado-Sánchez, Leticia Ferreyra-Reyes, Elizabeth Ferreira-Guerrero, Norma Mongua-Rodríguez, Rogelio Montero-Campos, Ada Melchor-Romero, Lourdes García-García
Journal: PLoS One (2015)
MeSH terms: AIDS-Related Opportunistic Infections / mortality, Acquired Immunodeficiency Syndrome / drug therapy, Anti-HIV Agents / therapeutic use, Antiretroviral Therapy, Highly Active, Respiratory Tract Infections / mortality, Research Support, Non-U.S. Gov't, AIDS-Related Opportunistic Infections / drug therapy, Acquired Immunodeficiency Syndrome / mortality, Adult, CD4 Lymphocyte Count, Female, Hospital Mortality, Humans, Male, Respiratory Tract Infections / drug therapy, Retrospective Studies, Social Class, Tertiary Care Centers, Treatment Outcome, Viral Load, Anti-HIV Agents

Background:
Respiratory manifestations of HIV disease differ globally due to differences in current availability of effective highly active antiretroviral therapy (HAART) programs and epidemiology of infectious diseases.
Objective:
To describe the association between HAART and discharge diagnosis and all-cause in-hospital mortality among hospitalized patients with infectious respiratory disease and HIV/AIDS.
Material and methods:
We retrospectively reviewed the records of patients hospitalized at a specialty hospital for respiratory diseases in Mexico City between January 1st, 2010 and December 31st, 2011. We included patients whose discharge diagnosis included HIV or AIDS and at least one infectious respiratory diagnosis. The information source was the clinical chart. We analyzed the association between HAART for 180 days or more and type of respiratory disease using polytomous logistic regression and all-cause hospital mortality by multiple logistic regressions.
Results:
We studied 308 patients, of whom 206 (66.9%) had been diagnosed with HIV infection before admission to the hospital. The CD4+ lymphocyte median count was 68 cells/mm3 [interquartile range (IQR): 30-150]. Seventy-five (24.4%) cases had received HAART for more than 180 days. Pneumocystis jirovecii pneumonia (PJP) (n = 142), tuberculosis (n = 63), and bacterial community-acquired pneumonia (n = 60) were the most frequent discharge diagnoses. Receiving HAART for more than 180 days was associated with a lower probability of PJP [Adjusted odd ratio (aOR): 0.245, 95% Confidence Interval (CI): 0.08-0.8, p = 0.02], adjusted for sociodemographic and clinical covariates. HAART was independently associated with reduced odds (aOR 0.214, 95% CI 0.06-0.75) of all-cause in-hospital mortality, adjusting for HIV diagnosis previous to hospitalization, age, access to social security, low socioeconomic level, CD4 cell count, viral load, and discharge diagnoses.
Conclusions:
HAART for 180 days or more was associated with 79% decrease in all-cause in-hospital mortality and lower frequency of PJP as discharge diagnosis. The prevalence of poorly controlled HIV was high, regardless of whether HIV was diagnosed before or during admission. HIV diagnosis and treatment resources should be improved, and strengthening of HAART program needs to be promoted.