Characteristics and outcomes of bacteremic pneumococcal pneumonia of patients with and without HIV infection in Argentina

Streptococcus pneumoniae is the main causative agent of pneumonia, with a 10 to 25 percent rate of isolation in blood cultures. Controversies exist regarding the prognostic impact of a history of human immunodeficiency virus (HIV) infection on community-acquired pneumonia. The aim of our work was to analyze and compare the clinical presentation, radiological findings and progression of pneumococcal pneumonia in patients infected with and not infected with HIV. We retrospectively analyzed adult patients with positive blood cultures for Streptococcus pneumoniae and clinical and radiological findings compatible with pneumonia in the period between January 2012 and May 2017. Age, sex, comorbidities, clinical and laboratory variables, radiological severity, progression and mortality were analyzed. Comparative analysis between HIV-positive and -negative patients was carried out. Receiver operating curves (ROC) for CURB65 were performed to predict mortality in both groups. We included 107 patients (21 HIV-positive and 86 HIV-negative). HIV patients were on average younger (38 vs 58 years) with lower hematocrits (31.7 vs 36.5%) and fewer comorbidities (47 vs 72%). Overall mortality was 36 percent, and the area under the curve (AUC) of the CURB-65 ROC was 0.69 (95% confidence interval: 0.58–0.79) for all patients without differences between the two groups. Patients with a history of HIV infection had the same progression and mortality as the group of patients without that background.