Abstract / Summary
Objectives: To compare the clinical characteristics, management, and outcomes of community-acquired pneumonia (CAP) caused by Haemophilus influenzae in people living with HIV (PWH) versus HIV-negative patients, and to evaluate whether HIV infection independently influences disease severity, intensive care unit (ICU) admission, or short- and long-term mortality.
Methods: We conducted a retrospective observational study of prospectively collected data including all consecutive adults hospitalized with CAP at a tertiary teaching hospital in Spain between 1996 and 2025. Microbiological confirmation of H. influenzae was obtained using standard diagnostic methods. Clinical variables, treatments, and outcomes were compared between PWH and HIV-negative patients. Propensity score matching (1:3) was applied to adjust for baseline differences. Multivariable generalized linear and Cox regression models were used to assess the association between HIV status and ICU admission, 30-day, 90-day, and 1-year mortality.
Results: Among 202 patients, 18 (9%) were PWH. Before matching, PWH were younger, more frequently current smokers, and had higher rates of chronic liver disease. After propensity score matching, 18 PWH were compared with 54 HIV-negative controls. No significant differences were observed in disease severity, complications, ICU admission, or mortality. No deaths occurred among PWH during follow-up. HIV status was not independently associated with ICU admission or mortality at any time point. However, confidence intervals were wide and the number of events was limited, reducing statistical power and precision of estimates.
Conclusions: In hospitalized patients with H. influenzae CAP, HIV infection was not associated with worse short- or long-term outcomes. However, given the small sample size and low number of outcome events, clinically meaningful differences cannot be excluded. Preventive strategies, including vaccination and optimized antiretroviral therapy, remain essential to reduce pneumonia burden in PWH.