Abstract:
BACKGROUND : Human immunodeficiency virus (HIV) contributes significantly to morbidity and mortality in South
Africa. Pneumonia and opportunistic infections remain a major cause for hospital admission among those living with
HIV, even in the era of the widespread availability of antiretroviral therapy.
METHODS : In this retrospective cohort study, the records of patients admitted with HIV and severe pneumonia,
requiring high care/intensive care admission, during a period of 12 months (February 2018 to January 2019) were
reviewed. Demographic details, antiretroviral use, HIV viral load, CD4 count, sputum culture results and radiological
imaging of patients were recorded. Data was analysed to determine variables associated with mortality.
RESULTS : One hundred and seventeen patient records were reviewed for this study. The patients were young (mean
age 38.3 years), had advanced disease with low CD4 counts (mean 120.2 cells/mm3) and high HIV viral loads (mean
594,973.7 copies/mL). Only 36.9% (42/117) were on highly active antiretroviral therapy (HAART) on presentation to the
hospital. Mycobacterium tuberculosis (M. tuberculosis) was found to be the cause for pneumonia in 35% (41/117), whilst
Pneumocystis jirovecii (P. jirovecii) was found in 21.4% (25/117). Bacterial pneumonia was the cause in 17.1% (20/117)
of patients while no specific aetiology was found in 26.6% (31/117) of patients in the cohort. Mortality among the
cohort studied was high (40.1%) and the average length of stay in hospital in excess of two weeks. The need for ICU
admission, ventilation and CMV viremia was associated with increased mortality. Chest X-ray findings did not correlate
with the aetiology of pneumonia, but multiple B-lines on lung ultrasound correlated with P. jirovecii as an aetiology
and there was a signal that pleural effusion with fibrin stranding predicts tuberculosis.
CONCLUSIONS : Patients studied presented with advanced HIV and were often naïve to antiretroviral therapy. Mortality
in this cohort of young patients was high, which emphasis the need for earlier diagnosis and treatment of HIV at a
primary care level. Lung ultrasound may have clinical utility in the management of patients with HIV and pneumonia,
particularly to diagnose P. jirovecii as an aetiology.
