Bacterial Pneumonia in Patients with the Acquired Immunodeficiency Syndrome

Polsky, Bruce; Gold, Jonathan W. M.; Whimbey, Estella; Dryjanski, José; Brown, Arthur E.; Schiffman, Gerald; Armstrong, Donald

doi:10.7326/0003-4819-104-1-38

Cited by 380 publications

(86 citation statements)

References 34 publications

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“…In particular, high nasal colonization of S. aureus (y50%) has been documented in HIV-infected subjects [20], especially in the advanced stage of HIV disease, with one report [21] suggesting a lower rate in patients who take trimethoprim-sulphamethoxazole as prophylaxis against PCP. The role of P. aeruginosa, Klebsiella pneumoniae and Escherichia coli as important agents of severe NBP (often due to antibiotic resistant strains) in patients with HIV infection was con®rmed in accordance with other reports [7,9].…”

Section: Discussionsupporting

confidence: 75%

Nosocomial bacterial pneumonia in human immunodeficiency virus infected subjects: incidence, risk factors and outcome

et al. 2001

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The presented study examined the incidence, risk factors and outcome of nosocomial bacterial pneumonia (NBP) in human immunodeficiency virus (HIV)-infected subjects. Forty-two cases of NBP were ascertained by a 5-yr prospective surveillance and were matched to 84 controls. NBP incidence was 10.8 per 10,000 hospital patient-days. In particular, the incidence of NBP was 13.9 per 10,000 patient-days in the period 1994–1996 and 5.6 per 10,000 patient-days in the period 1997–1998 (p=0.01).By using regression analysis, predictors for developing NBP were an increasing value of Acute Physiology and Chronic Health Evaluation (APACHE) III score (p<0.01) and the presence of acquired immune deficiency syndrome (AIDS)-related central nervous system (CNS) diseases (p=0.01). The additional hospital stay attributable to NBP was 15 days. The attributable mortality rate was estimated to be 29%.Nosocomial bacterial pneumonia is more common in patients with advanced human immunodeficiency virus infection, high Acute Physiology and Chronic Health Evaluation III score and central nervous system diseases. Although the incidence of nosocomial bacterial pneumonia, as well of other opportunistic infections, decreased considerably in the era of highly active antiretroviral therapy, it still represents an important cause of mortality.

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Section: Discussionsupporting

confidence: 75%

Nosocomial bacterial pneumonia in human immunodeficiency virus infected subjects: incidence, risk factors and outcome

et al. 2001

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“…However, there were big differences between individuals, as usually found when protein levels or antibody activities are measured in secretions, not allowing easy grouping of any given case into certain categories of immunocompetence or immunodeficiencies. In response to an infectious pathogen, decreased production of opsonizing antibodies in AIDS patients may explain the increased prevalence of bacterial pulmonary infections [42]. In normal subjects, antibody activities of secretory IgA can be induced either by local respiratory immunization and natural infection or by exposure [43].…”

Section: Discussionmentioning

confidence: 99%

Humoral immune response within the lung in HIV-1 infection

Moja¹,

Jalil²,

Quesnel³

et al. 1997

Clinical and Experimental Immunology

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In order to study the humoral immune defences in the respiratory tract during HIV‐1 infection, we measured the levels, local productions and anti‐HIV and antibacterial activities of IgG and IgA in the bronchoalveolar lavage fluid (BALF) and serum of 61 adult patients with severe HIV infection and of 56 HIV− controls. Albumin was used as the serum transudation factor. The increase of immunoglobulin levels in the serum of HIV‐infected patients was confirmed. The IgG level was also increased in epithelial lining fluid (ELF), whereas the total IgA level was unchanged and secretory IgA (SIgA) level was decreased. The ELF/serum immunoglobulin ratios suggested that the IgG present in ELF resulted mainly from transudation, in contrast to SIgA, which was synthesized locally in controls but greatly diminished in HIV‐infected patients. IgG to HIV‐1 could be detected in BALF of all the patients, but IgA to HIV‐1 only in 30% of patients. BAL IgG reacted more consistently and with a broader array of HIV‐1 antigens than did IgA. BAL IgA, when present in samples, reacted primarily with viral envelope antigens. Because IgA specificities to some HIV‐1 antigens were detected more intensively by BAL than by serum immunoglobulins, we conclude that the mucosal immune response is distinct from that in serum. IgG antibody activity to Streptococcus pneumoniae was decreased in HIV‐infected patients' sera, and IgA antibody activities to S. pneumoniae and to Pseudomonas aeruginosa were decreased in ELF in HIV‐infected patients.

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“…Bacterial pneumonia is well known to occur at excess rates in persons with HIV infection (1)(2)(3)(4)(5). Since the early years of the HIV epidemic, high rates of bacterial infections were reported in patients with AIDS and HIV infection (1-3, 6, 7).…”

mentioning

confidence: 99%

“…Even a single episode of bacterial pneumonia is associated with substantial morbidity and mortality (2)(3)(4)(5)(6)9).…”

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confidence: 99%

Pneumonia in HIV-infected Persons

Gordin¹,

Roediger²,

Girard

et al. 2008

Am J Respir Crit Care Med

102

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Rationale: Bacterial pneumonia is a major cause of morbidity for HIVinfected 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 5 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 5 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. Clinical trial registered with www.clinicaltrials.gov (NCT 00027352).

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Bacterial Pneumonia in Patients with the Acquired Immunodeficiency Syndrome

Cited by 380 publications

References 34 publications

Nosocomial bacterial pneumonia in human immunodeficiency virus infected subjects: incidence, risk factors and outcome

Nosocomial bacterial pneumonia in human immunodeficiency virus infected subjects: incidence, risk factors and outcome

Humoral immune response within the lung in HIV-1 infection

Pneumonia in HIV-infected Persons

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