Clinical and Laboratory Predictors of 30-Day Mortality in HIV-Positive Adults with Pneumonia: A Prospective Observational Study from North India

Background: Pneumonia remains a major cause of morbidity and mortality among people living with HIV (PLHIV), particularly in low- and middle-income countries. Despite the availability of antiretroviral therapy (ART), early mortality after hospitalization for pneumonia remains high. Indian data on short-term mortality predictors in HIV-associated pneumonia are limited. Methods: We conducted a prospective observational study of HIV-positive adults admitted with pneumonia to a tertiary-care hospital in North India between April and December 2025. Clinical, laboratory, microbiological, and radiological parameters were recorded at admission. Patients were followed for 30 days. The primary outcome was all-cause 30-day mortality. Predictors of mortality were assessed using univariate analysis and multivariable logistic regression. Results: Fifty HIV-positive adults were included. The study flow is shown in Figure 1. Baseline characteristics are summarized in Table 1. Thirty-day mortality was 72%. Hypotension at admission and requirement of inotropic support were independently associated with mortality (Table 2). Disseminated tuberculosis was strongly associated with death. ROC analysis of laboratory predictors is presented in Table 3. Conclusions: Mortality among HIV-positive adults hospitalized with pneumonia remains alarmingly high. Hemodynamic instability and tuberculosis are dominant drivers of early mortality. Early recognition of shock and prompt tuberculosis management are essential to improve outcomes.