Pneumonia in HIV-infected Persons: Increased Risk with Cigarette Smoking and Treatment Interruption

• Published in: American journal of respiratory and critical care medicine 2008-09, Vol.178 (6), p.630-636
• Main Authors: Gordin, Fred M, Roediger, Mollie P, Girard, Pierre-Marie, Lundgren, Jens D, Miro, Jose M, Palfreeman, Adrian, Rodriguez-Barradas, Maria C, Wolff, Marcelo J, Easterbrook, Philippa J, Clezy, Kate, Slater, Leonard N
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anti-Retroviral Agents - therapeutic use; Bacterial infections; Biological and medical sciences; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; E. Pulmonary Infections; Female; HIV; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - mortality; Human immunodeficiency virus; Humans; Intensive care medicine; Male; Medical sciences; Middle Aged; Mortality; Pneumonia, Bacterial - epidemiology; Pneumonia, Staphylococcal - epidemiology; Proportional Hazards Models; Risk Factors; Smoking - epidemiology; Transfusions. Complications. Transfusion reactions. Cell and gene therapy
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.200804-617OC

Bacterial pneumonia is a major cause of morbidity for HIV-infected persons and contributes to excess mortality in this population. To evaluate the frequency and risk factors for occurrence of bacterial pneumonia in the present era of potent antiretroviral therapy. 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. 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. 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.