The clinical presentation and outcomes (length of hospital stay [LOS], intensive care unit [ICU] admission, 30-day mortality) of Legionella pneumonia in patients with HIV did not differ from those of patients without HIV infection, according to a study published in Clinical Infectious Diseases.
In this multicenter, observational study, case patients were defined as HIV-infected adults (age, ≥18 years) with a diagnosis of community-acquired Legionella pneumonia between 1994 and 2016 in 3 Spanish hospitals (1 in Badalona, 2 in Barcelona). Three control cases of patients with Legionella pneumonia without HIV infection were selected for each case patient; matched criteria included similar age (±10 years) and same center, sex, baseline pneumonia severity index score of I to III or IV to V, and pneumonia diagnosis in the same calendar period ±1 year. LOS, ICU admission, and 30-day mortality were the study outcomes.
Results showed that individuals with HIV presented neither a more severe disease nor a worse clinical outcome than matched control patients who were HIV-negative. Nine percent of cases and 16% of control patients required ICU admission (P =.56). Mechanical ventilation was needed in 6% of cases and 6% of control patients (P >.99). LOS averaged 7 days in the case group and 6 days in the control group (P =.39).
In a multivariate analysis, multilobar involvement and white blood cell count <10×109 cell/L were associated with ICU admission. HIV infection was not associated with ICU admission or increased LOS in the univariate analyses, even after adjustments for case patients and potential confounding factors in the multivariate analyses. In a univariate analysis of HIV-infected patients, a relationship between ICU admission or LOS and antiretroviral therapy or having a plasma HIV RNA viral load <200 copies/mL or a CD4+ cell count <200 cell/µL was not observed.
The study authors concluded that in regard to Legionella pneumonia, “the management of these HIV-infected patients should be the same as for HIV-uninfected individuals and should be included in [community-acquired pneumonia] management guidelines.”
Cillóniz C, Miguel-Escuder L, Pedro-Bonet ML, et al; Legionella-HIV researchers. Community-acquired Legionella pneumonia in HIV-infected adult patients: a matched case-control study [published online April 12, 2018]. Clin Infect Dis. doi: 10.1093/cid/ciy314