Effect of Antiretroviral Therapy on the Incidence of Bacterial Pneumonia in Patients with Advanced HIV Infection [Sullivan JH, et al. Am J Respir Crit Care Med 2000; 162: 64]: The authors report an analysis of the Moore Clinic database from Johns Hopkins University on the experience with bacterial pneumonia among 1,898 HIV-infected patients with CD4 counts < 200/mm³ for the period 1993 - 1998. There were 352 episodes of pneumonia with an incidence of 22.7 episodes/100 person-years in the first half of 1993 with a decrease to a nadir of 9.1 episodes/100 person-years in the second half of 1997 (P = < 0.05). Risk factors for bacterial pneumonia included low CD4 cell counts, lack of a protease inhibitor-containing regimen, prior P. carinii pneumonia and injection drug use. The authors concluded that there has been a substantial decrease in bacterial pneumonia associated with HAART.
Comment: Bacterial pneumonia (or "enigmatic pneumonia") remains the major cause of death in persons with HIV infection. This study shows that the rate of presumed bacterial pneumonia has declined with the availability of more effective antiretroviral therapy. Thus, this "opportunistic infection" occurs less frequently among patients with immune reconstitution. This report, as well as others, shows that injection drug use and low CD4 cell counts both represent risks for bacterial pneumonia. Others have also shown that prophylaxis with TMP-SMX or macrolides is associated with a decreased risk; this was not shown in the present study for reasons that are unexplained. posted 8/3/2000