Community-acquired Pneumonia in People With Human Immunodeficiency Virus (HIV) During the Current Era of Effective Antiretroviral Therapy: A Multicenter Retrospective Cohort Study

Abstract

Abstract Background It is unclear if human immunodeficiency virus (HIV) affects the prognosis for community-acquired pneumonia (CAP) in the current era of effective antiretroviral therapy. In this multicenter retrospective cohort study of patients admitted for CAP, we compared the in-hospital mortality rate between people with HIV (PWH) and those without. Methods The study included consecutive patients admitted with a diagnosis of CAP across 31 hospitals in Ontario, Canada, from 2015 to 2022. HIV infection was based on discharge diagnoses and antiretroviral prescription. The primary outcome was in-hospital mortality. Competing risk models were used to describe time to death in hospital or discharge. Potential confounders were balanced using overlap weighting of propensity scores. Results Of 82 822 patients admitted with CAP, 1518 (1.8%) had a diagnosis of HIV. PWH were more likely to be younger, male, and have fewer comorbidities. In the hospital, 67 (4.4%) PWH and 6873 (8.5%) people without HIV died. HIV status had an adjusted subdistribution hazard ratio of 1.02 (95% confidence interval, .80–1.31; P = .8440) for dying in the hospital. Of 1518 PWH, 440 (29.0%) patients had a diagnosis of AIDS. AIDS diagnosis had an adjusted subdistribution hazard ratio of 3.04 (95% CI, 1.69–5.45; P = .0002) for dying in the hospital compared to HIV without AIDS. Conclusions People with and without HIV admitted for CAP had a similar in-hospital mortality rate. For PWH, AIDS significantly increased the mortality risk. HIV infection by itself without AIDS should not be considered a poor prognostic factor for CAP.