{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:50:57Z","timestamp":1791910257269,"version":"4.3.4"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004319","name":"Pfizer","doi-asserted-by":"publisher","award":["WI230621"],"award-info":[{"award-number":["WI230621"]}],"id":[{"id":"10.13039\/100004319","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Perinatal HIV Research Unit","id":[{"id":"https:\/\/ror.org\/05j6xkp39","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Wits Health Consortium","id":[{"id":"https:\/\/ror.org\/02a496f07","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Community-acquired pneumonia (CAP) is a leading cause of death in adults, but recent data in people with HIV (PWH) are lacking. We studied South African adults hospitalized with CAP to describe mortality and risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We prospectively enrolled consenting adults aged \u226518 years hospitalized with CAP, as defined by symptoms, signs, and chest x-ray, from March 2019 to October 2021 in 3 South African hospitals. Blood, sputum, nasopharyngeal\/oropharyngeal swabs, and urine were tested for HIV, tuberculosis, SARS-CoV-2, influenza, respiratory syncytial virus, and Streptococcus pneumoniae. Participants were followed for 1 year. Causes of death were defined following record review. Timing and risk factors for death were evaluated by Kaplan-Meier and Cox analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 2000 adults (median age, 46 years), 1079 (54.0%) were PWH. Among 994 with HIV viral load results, 289 (29.1%) were virally suppressed, and among 1556 tested for SARS-CoV-2, 700 (45.0%) were positive. There were 569 (28.5%) deaths, and the majority died early: 47.7% during hospitalization and 10.6% \u226430 days postdischarge. Leading underlying causes of death were COVID-19 (23.0%), tuberculosis (16.9%), and advanced HIV (13.2%). Age \u226545 years (hazard ratio, 2.7; 95% CI, 1.5\u20134.6), active tuberculosis (1.6, 1.2\u20132.0), unsuppressed HIV viral load (1.4, 1.0\u20131.9), anemia (1.3, 1.0\u20131.6), underweight (1.3, 1.0\u20131.7), and low admission oxygen saturation (&amp;lt;94% on room air; 1.3, 1.0\u20131.6) were associated with mortality. Mortality was higher in PWH (18.2 vs 11.7 per 100 person-years) but similar between PWH who were virally suppressed and unsuppressed (21.3 vs 24.7 per 100 person-years).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In-hospital and postdischarge CAP mortality remains high, particularly among PWH, regardless of virologic status, warranting urgent investigation of mitigation strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag594","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T19:34:58Z","timestamp":1789673698000},"source":"Crossref","is-referenced-by-count":0,"title":["High Mortality in Adults With Community-Acquired Pneumonia Admitted to Hospitals in South Africa Before and During the COVID-19 Pandemic, Stratified by HIV Serostatus and Viral Load: Data From a Prospective Cohort Study (2019\u20132021)"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9402-0974","authenticated-orcid":false,"given":"Nadia","family":"Sabet","sequence":"first","affiliation":[{"name":"Perinatal HIV Research Unit, University of the Witwatersrand , Johannesburg ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Firdaus","family":"Nabeemeeah","sequence":"additional","affiliation":[{"name":"Perinatal HIV Research Unit, University of the Witwatersrand , Johannesburg ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kennedy","family":"Otwombe","sequence":"additional","affiliation":[{"name":"Perinatal HIV Research Unit, University of the Witwatersrand , Johannesburg ,","place":["South Africa"]},{"name":"School of Public Health, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khuthadzo","family":"Hlongwane","sequence":"additional","affiliation":[{"name":"Perinatal HIV Research Unit, University of the Witwatersrand , Johannesburg ,","place":["South Africa"]},{"name":"School of Public Health, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lebohang M","family":"Mlambo","sequence":"additional","affiliation":[{"name":"Perinatal HIV Research Unit, University of the Witwatersrand , Johannesburg ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tumelo","family":"Moloantoa","sequence":"additional","affiliation":[{"name":"Perinatal HIV Research Unit, University of the Witwatersrand , Johannesburg ,","place":["South 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,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Floris","family":"Swanepoel","sequence":"additional","affiliation":[{"name":"Perinatal HIV Research Unit, University of the Witwatersrand , Johannesburg ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0243-7455","authenticated-orcid":false,"given":"Anne","family":"von Gottberg","sequence":"additional","affiliation":[{"name":"Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service , Johannesburg ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0376-2302","authenticated-orcid":false,"given":"Cheryl","family":"Cohen","sequence":"additional","affiliation":[{"name":"School of Public Health, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg ,","place":["South Africa"]},{"name":"Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service , Johannesburg ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9186-0679","authenticated-orcid":false,"given":"Mignon","family":"du Plessis","sequence":"additional","affiliation":[{"name":"Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service , Johannesburg ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo","family":"Southern","sequence":"additional","affiliation":[{"name":"Medical Evidence Development Vaccines, Chief Medical Affairs Office, Pfizer Inc , Collegeville, Pennsylvania ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark A","family":"Fletcher","sequence":"additional","affiliation":[{"name":"Pfizer Vaccines Research & Development, Medical Affairs, International Emerging Markets , Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5542-0780","authenticated-orcid":false,"given":"Eileen M","family":"Dunne","sequence":"additional","affiliation":[{"name":"Medical Evidence Development Vaccines, Chief Medical Affairs Office, Pfizer Inc , Collegeville, Pennsylvania ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradford D","family":"Gessner","sequence":"additional","affiliation":[{"name":"Medical Evidence Development Vaccines, Chief Medical Affairs Office, Pfizer Inc , Collegeville, Pennsylvania ,","place":["USA"]},{"name":"EpiVac Consulting , Anchorage, Alaska ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bha","family":"Ndungane-Tlakula","sequence":"additional","affiliation":[{"name":"Pfizer , Johannesburg ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4654-8755","authenticated-orcid":false,"given":"Minja","family":"Milovanovic","sequence":"additional","affiliation":[{"name":"Perinatal HIV Research Unit, University of the Witwatersrand , Johannesburg ,","place":["South Africa"]},{"name":"African Potential Collaborative, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2888-789X","authenticated-orcid":false,"given":"Ebrahim","family":"Variava","sequence":"additional","affiliation":[{"name":"Perinatal HIV Research Unit, University of the Witwatersrand , Johannesburg ,","place":["South 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