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Previous Volume 333:845-851 September 28, 1995 Number 13 Next

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ABSTRACT

Background Patients with human immunodeficiency virus (HIV) infection are at increased risk for bacterial pneumonia in addition to opportunistic infection. However, the risk factors for bacterial pneumonia and its incidence in this population are not well defined.

Methods In a multicenter, prospective, observational study, we monitored 1130 HIV-positive and 167 HIV-negative participating adults for up to 64 months for pulmonary disease. The HIV-positive group comprised 814 homosexual or bisexual men, 261 injection-drug users, and 55 female partners of HIV-infected men.

Results There were 237 episodes of bacterial pneumonia among the HIV-positive participants (rate, 5.5 per 100 person-years), as compared with 6 episodes among the HIV-negative participants (rate, 0.9 per 100 person-years; P<0.001). The rate of bacterial pneumonia increased with decreasing CD4 lymphocyte counts (2.3, 6.8, and 10.8 episodes per 100 person-years in the strata with more than 500, 200 to 500, and fewer than 200 cells per cubic millimeter, respectively; P<0.022 for each comparison). Injection-drug users had a higher rate of bacterial pneumonia than did homosexual or bisexual men or female partners. In the stratum with the fewest CD4 lymphocytes, cigarette smoking was associated with an increased rate of pneumonia. Mortality was almost four times higher among participants with an episode of pneumonia than among the others. Prophylaxis with trimethoprim–sulfamethoxazole was associated with a 67 percent reduction in confirmed episodes of bacterial pneumonia (P = 0.007).

Conclusions Bacterial pneumonia is more frequent in HIV-positive persons than in seronegative controls, and the risk is highest among those with CD4 lymphocyte counts below 200 per cubic millimeter and among injection-drug users.

Source Information

From the sections of Infectious Diseases and Pulmonary Medicine, Northwestern University, Chicago (R.E.H., J.G.); Research Triangle Institute, Research Triangle Park, N.C. (M.C.J., T.C.W.); the University of California, Los Angeles (J.M.W.); Henry Ford Hospital, Detroit (P.A.K., N.M.); Beth Israel Medical Center, New York (M.J.R.); the University of Medicine and Dentistry of New Jersey, Newark (B.T.M.); and the University of California, San Francisco (P.C.H.).

Address reprint requests to Dr. Hirschtick at Northwestern University, 303 E. Superior, Passavant 828, Chicago, IL 60611.

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