Pneumococcal pneumonia in adult hospitalized patients infected with the human immunodeficiency virus

Abstract

Purpose: To determine the attack rate; clinical, radiologic, and laboratory characteristics; and outcome of pneumococcal pneumonia in patients infected with the human immunodeficiency virus (HIV) and to compare these characteristics with those of pneumococcal pneumonia in the general population.

Patients and methods: This is a retrospective (13-month), prospective (14-month) study. All adult hospitalized patients with pulmonary infiltrates and isolation of Streptococcus pneumoniae in blood, pleural fluid, transtracheal aspirate, or respiratory secretions obtained by plugged telescoped catheter (counts greater than 10(3) colony-forming units per milliliter) are included.

Main results: We identified 22 HIV-infected patients and 84 HIV-seronegative patients with pneumococcal pneumonia (76% and 56%, respectively, were bacteremic). The estimated attack rate was 5.9 per 1000 for HIV-infected patients and 0.31 per 1000 for HIV-seronegative patients. Pneumococcal pneumonia was the first manifestation of HIV infection in 48% of cases. Seventy-two percent of patients younger than 40 years of age with pneumococcal pneumonia were HIV infected. No predisposing factors for pneumococcal pneumonia were identified in 76% and 2% of HIV seropositive and seronegative patients, respectively. Clinical and radiologic presentation was similar in the two populations. Of all S pneumoniae isolates, 35% were resistant to penicillin and 10% to erythromycin, without differences in the two groups. Prognosis was good, with only one infection-related death in the HIV-infected group (10 patients died in the other group). No relapses were documented in HIV-infected patients.

Conclusion: The HIV-infected patient is at increased risk for pneumococcal pneumonia and bacteremia. Patients younger than 40 years of age who present with pneumococcal pneumonia should be considered for HIV testing, since it may be the first manifestation of HIV infection. Specific antimicrobial therapy is curative in the majority of HIV-infected patients.