Clinical Characteristics Of Community Acquired Pneumonia In Human Immunodeficiency Virus-infected Patients

Background:By the end of 2016,there were about 654 thousand of HIV-infected patients in China,and the cumulative death were 201 thousand.CAP was a common complication in HIV-infected patients.With the epidemic of HIV infection,there were many HIV-infected adults first hospitalized in the department of respiration.It was difficult for doctors to obtain the history which had any suggestion to HIV infection because of privacy concerns,and HIV antibody screening was not a routine test,such patients were proned to be misdiagnosed.However,treatment principles between HIV-infected CAP patients and non HIV-infected CAP patients were different.Therefore,grasping the clinical features of HIV-infected CAP patients is important.Objective:Find the clinical characteristics which can be used to identify HIV-infected CAP patients and routine laboratory parameters which can be used to monitor disease severity.Methods:Using retrospective analysis method.Collecting HIV-infected patients admitted to the first hospital of Ji Lin University during 2014.12 to 2016.03,of whom complicated with CAP set for "HIV+CAP group",randomed selecting 80 cases of non HIV-infected community acquired pneumonia patients set for "CAP group".Compared population characteristics(age,gender,previous history),clinical manifestations,routine laboratory parameters,chest images,anti-infection efficacy,severity,between "HIV+CAP group" and "CAP group".Giving correlation analysis between routine laboratory parameters and PSI score in "HIV+CAP group".Results:1.There were 113 cases of HIV-infected patients admitted to our hospital due to various complications during 2014.12-2016.3,of whom76 cases(67%)being admitted to hospital due to CAP,37 cases(33%)due to other complications.2.Compared to "CAP group","HIV +CAP group" as to population characteristics,were more common seen in younger males(P<0.001),and the past history of syphilis infection were more common(P<0.001);as to clinical manifestations,having higher proportion of fever and dyspnea(P<0.001,P<0.001);as to routine laboratory parameters,having higher proportion of lymphopenia,anemia,hypoalbuminemia(P<0.001,P<0.001,P<0.001);as to chest images,having more proportion of ground glass opacity(P<0.001);as to anti-infection efficacy and pneumonia severity,having a worse respose to anti-infection treatment(P<0.001),and moreprone to have severe pneumonia(P<0.001).3.There were 14 severe CAP patients and 62 non-severe CAP patients in "HIV+CAP group".Compared to non-severe CAP patients,severe CAP patients had lower lymphocyte counts,hemoglobin,albumin(P=0.044,P=0.009,P=0.047),higher CRP,D-D(P=0.041,P=0.042),there were no statistically significant differences in platelets and ESR.Correlation analysis of routine laboratory parameters and PSI score in "HIV+CAP group" : total lymphocyte counts,hemoglobin,albumin in "HIV+CAP" group were negatively correlated with PSI score,the correlation coefficient of rs were-0.30(P=0.012),-0.40(P=0.045),-0.39(P=0.001),respectively;CRP,D-D were positively correlated with PSI score,the correlation coefficient of rs were 0.30(P=0.024)and0.56(P=0.001),respectively;there were no statistically differences between platelets and PSI,rs=0.50(P=0.667);there were no statistically differences between ESR and PSI,rs=0.20(P=0.375).Conclusion:1.Young and middle-aged male CAP patients,manifesting fever and dyspnea,presenting with lymphopenia,anemia,hypoalbuminemia,imagig of ground glass opacity,HIV-infection should be taken into consideration.2.Efficacy of routine anti–infection treatments are worse in HIV-infected CAP patients,and HIV-infected patients are more prone to have severe pneumonia.3.Total lymphocytes counts,hemoglobin,albumin,CRP,D-D can be used to reflect the severity of CAP in HIV-infected patients.