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Background: Individualized selection of antiretroviral (ARV) therapy is complex, considering drug resistance, comorbidities, drug-drug interactions, and other factors. HIV-ASSIST (www.hivassist.com) is a free, online tool that provides ARV decision support. HIV-ASSIST synthesizes patient and virus-specific attributes to rank ARV combinations based upon a composite objective of achieving viral suppression and maximizing tolerability., Objective: To evaluate concordance of HIV-ASSIST recommendations with ARV selections of experienced HIV clinicians., Design: Retrospective cohort study., Patients: New and established patients at the Johns Hopkins Bartlett HIV Clinic and San Francisco Veterans Affairs HIV Clinic completing clinic visits were included. Chart reviews were conducted of the most recent clinic visit to generate HIV-ASSIST recommendations, which were compared to prescribed regimens., Main Measures: For each provider-prescribed regimen, we assessed its corresponding HIV-ASSIST "weighted score" (scale of 0 to 10 +, scores of < 2.0 are preferred), rank within HIV-ASSIST's ordered listing of ARV regimens, and concordance with the top five HIV-ASSIST ranked outputs., Key Results: Among 106 patients (16% female), 23 (22%) were ARV-naïve. HIV-ASSIST outputs for ARV-naïve patients were 100% concordant with prescribed regimens (median rank 1 [IQR 1-3], median weighted score 1.1 [IQR 1-1.2]). For 18 (17%) ARV-experienced patients with ongoing viremia, HIV-ASSIST outputs were 89% concordant with prescribed regimens (median rank 2 [IQR 1-3], median weighted score 1 [IQR 1-1.2]). For 65 (61.3%) patients that were suppressed on a current ARV regimen, HIV-ASSIST recommendations were concordant 88% of the time (median rank 1 [IQR 1-1], median weighted score 1.1 [IQR 1-1.6]). In 18% of cases, HIV-ASSIST weighted score suggested that the prescribed regimen would be considered "less preferred" (score > 2.0) than other available alternatives., Conclusion: HIV-ASSIST is an educational decision support tool that provides ARV recommendations concordant with experienced HIV providers from two major academic centers for a diverse set of patient scenarios.

Data on outcomes of community-acquired pneumonia (CAP) in the HIV-infected population are mixed and the perception of worse outcomes in HIV may lead to excess hospitalization. We retrospectively evaluated the utility of the Pneumonia Severity Index, or PORT score, as a prediction rule for mortality in 102 HIV-infected adults hospitalized at an urban public hospital with CAP. Primary outcome was survival at 30 days. Secondary outcomes included survival on discharge, intensive care unit (ICU) admission, length of stay, and readmission within 30 days. The cohort was predominantly male (70%) with a mean age of 45.4 years (standard deviation [SD] ± 7.4). Mean CD4 cell count was 318 cells per microliter; 40 (39%) had CD4 less than 200 cells per microliter. Forty-three percent were on antiretroviral therapy at the time of admission and 31% on prophylactic antibiotics. Twelve patients had bacteremia on admission, predominantly with Streptococcus pneumoniae. Of the 46 patients with admission sputum cultures, 20 yielded an organism, most commonly Haemophilus influenzae and S. pneumoniae. Overall survival in the cohort was high, 96%. Most patients (81%) had a low PORT risk score (class I-III). PORT score predicted 30-day survival (p=0.01) and ICU admission (p=0.03), but antiretroviral use did not. In contrast to a prior study, we did not find that CD4 cell count predicted CAP outcome. Lack of stable housing was not associated with worse outcomes. The PORT score may be a valid tool to predict mortality and need for hospital admission in HIV-infected patients with CAP.