Community-acquired bacterial pneumonia in adult HIV-infected patients

Abstract

Despite active antiretroviral therapy (ART), community-acquired pneumonia (CAP) remains a major cause of morbidity and mortality among human immunodeficiency virus (HIV)-infected patients and incurs high health costs. Areas covered: This article reviews the most recent publications on bacterial CAP in the HIV-infected population, focusing on epidemiology, prognostic factors, microbial etiology, therapy, and prevention. The data discussed here were mainly obtained from a non-systematic review using Medline, and references from relevant articles. Expert commentary: HIV-infected patients are more susceptible to bacterial CAP. Although ART improves their immune response and has reduced CAP incidence, these patients continue to present increased risk of pneumonia in part because they show altered immunity and because immune activation persists. The risk of CAP in HIV-infected patients and the probability of polymicrobial or atypical infections are inversely associated with the CD4 cell count. Mortality in HIV-infected patients with CAP ranges from 6% to 15% but in well-controlled HIV-infected patients on ART the mortality is low and similar to that seen in HIV-negative individuals. Vaccination and smoking cessation are the two most important preventive strategies for bacterial CAP in well-controlled HIV-infected patients on ART.

Case fatality rate and viral aetiologies of acute respiratory tract infections in HIV positive and negative people in Africa: The VARIAFRICA-HIV systematic review and meta-analysis

“…The specific pathogenesis that may explain the association between HIV infection and the increased risk of death in patients with acute respiratory infections is not well understood. Unlike our review, studies conducted outside Africa suggested that the presence of HIV infection did not influence the clinical outcomes of people with ARTI [57][58][59][60]. This difference can be explained by the fact that people living with HIV in Africa compared to developed countries can experience more limited access to healthcare for advanced HIV disease, malnutrition, parasitic diseases, and low antiretroviral treatment coverage [57,58,60].…”

“…One of the most important point to curb the burden of ARTI is to early initiate antiretroviral treatment among all HIV positive people regardless of CD4 cells count and age as recommended by World Health Organization (WHO) [74]. Antiretroviral treatment has been shown to reduce the frequency of most opportunistic infections and significantly reduce HIV-related mortality, including among people with respiratory tract infections [57][58][59][60]. However, implementing this WHO guidelines remain challenging in Africa, a continent with poor human and financial resources and weak healthcare infrastructures [75].…”

Coronavirus disease 2019 (COVID‐19) outcomes in HIV/AIDS patients: a systematic review

“…Patients with HIV show a higher incidence of bacterial pneumonia, which is inversely proportional to CD4 T-Cell count, when compared to the general population. Thus, superimposed bacterial pneumonia with COVID-19 is a significant consideration in PLHIV [25][26][27][28][29].…”

New HIV diagnoses in patients with COVID-19: two case reports and a brief literature review

“…Patients with HIV show a higher incidence of bacterial pneumonia, which is inversely proportional to the CD4 + T cell count, when compared to the general population. Thus, superimposed bacterial pneumonia with COVID-19 is a significant consideration in PLHIV [20]. We admitted that these cases we reported could not rule out HIV-related opportunistic infections due to an urgent study and limit resource, we suspected but did not confirm PJP infection.…”