Pneumonia in HIV-infected Persons

August 29, 2008 at 6:12 pm Leave a comment

American Journal of Respiratory and Critical Care Medicine  15 Sept 2008  V.178  N.6  p.630-636

Original Article

Increased Risk with Cigarette Smoking and Treatment Interruption

Fred M. Gordin1, Mollie P. Roediger2, Pierre-Marie Girard3, Jens D. Lundgren4, Jose M. Miro5, Adrian Palfreeman6, Maria C. Rodriguez-Barradas7, Marcelo J. Wolff8, Philippa J. Easterbrook9, Kate Clezy10 and Leonard N. Slater11

1 Veterans Affairs Medical Center and George Washington University, Washington, DC; 2 Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota; 3 Service des Maladies Infectieuses et Tropicales–Hôpital Saint-Antoine, Université Pierre et Marie Curie, and Institut Médecine et d’Epidémiologie Appliquée, Paris, France; 4 Copenhagen HIV Programme, University of Copenhagen, Copenhagen, Denmark; 5 Hospital Clinic–Institut d’Investigacions Biomèdiques August Pi-Sunyer, University of Barcelona, Barcelona, Spain; 6 University Hospitals of Leicester, Leicester, and Medical Research Council, London, United Kingdom; 7 Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas; 8 University of Chile School of Medicine and Arriaran Foundation, Santiago, Chile; 9 Department of HIV and Genitourinary Medicine, Kings College, London, United Kingdom; 10 University of New South Wales, Sydney, Australia; 11 University of Oklahoma College of Medicine and Veterans Affairs Medical Center, Oklahoma City, Oklahoma

Rationale: Bacterial pneumonia is a major cause of morbidity for HIV-infected persons and contributes to excess mortality in this population.

Objectives: To evaluate the frequency and risk factors for occurrence of bacterial pneumonia in the present era of potent antiretroviral therapy.

Methods: We evaluated data from a randomized trial of episodic antiretroviral therapy. The study, Strategies for Management of Antiretroviral Therapy, enrolled 5,472 participants at 318 sites in 33 countries. Study patients had more than 350 CD4 cells at baseline. Diagnosis of bacterial pneumonia was confirmed by a blinded clinical-events committee.

Measurements and Main Results: During a mean follow-up of 16 months, 116 participants (2.2%) developed at least one episode of bacterial pneumonia. Patients randomized to receive episodic antiretroviral therapy were significantly more likely to develop pneumonia than patients randomized to receive continuous antiretroviral therapy (hazard ratio, 1.55; 95% confidence interval, 1.07–2.25; P = 0.02). Cigarette smoking was a major risk factor: Current-smokers had more than an 80% higher risk of pneumonia compared with never-smokers (hazard ratio, 1.82; 95% confidence interval, 1.09–3.04; P = 0.02). Participants who were on continuous HIV treatment and were current smokers were three times more likely to develop bacterial pneumonia than nonsmokers. Current smoking status was significant, but a past history of smoking was not.

Conclusions: Bacterial pneumonia is a major source of morbidity, even for persons on potent antiretroviral therapy, including those with high CD4 cells. Efforts to reduce this illness should stress the importance of uninterrupted antiretroviral therapy and attainment and/or maintenance of nonsmoking status.


Entry filed under: Bacterias, Epidemiología, HIV/SIDA Trastornos respiratorias, Infecciones respiratorias.

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