title: Effect of antiretroviral therapy on the incidence of bacterial pneumonia in patients with advanced HIV infection.
abstract: To determine the relationship of combination antiretroviral therapy and bacterial pneumonia, we assessed incidence of and risk factors for bacterial pneumonia in 1,898 human immunodeficiency virus (HIV)-infected patients with CD4 cell counts < 200/mm(3) followed in the Johns Hopkins HIV clinic between 1993 and 1998. A total of 352 episodes of bacterial pneumonia occurred during 2,310 patient-years of follow-up. Incidence of bacterial pneumonia decreased from 22.7 episodes/100 person-years (py) in the first half of 1993 to 12.3 episodes/100 py in the first half of 1996, reaching a nadir of 9.1 episodes/100 py in the second half of 1997 (p < 0.05). The use of protease inhibitor-containing regimens was associated with a decreased risk of bacterial pneumonia (risk ratio [RR] 0.55, 95% CI 0.31 to 0.94). Lower CD4 cell counts (RR 2.22, 95% CI 1.54 to 3.18), injection drug use as HIV transmission category (RR2.0, 95% CI 1.43 to 2.76), and prior Pneumocystis carinii pneumonia (RR 3.88, 95% CI 1.65 to 9.16) were also significantly associated with bacterial pneumonia. Trimethoprim-sulfamethoxazole and macrolide use were not significantly associated with risk of bacterial pneumonia. There has been a dramatic decline in the incidence of bacterial pneumonia resulting from the use of combination antiretroviral therapy containing protease inhibitors.
authors.affiliation: Johns Hopkins School of Medicine, Baltimore, Maryland 21287-0003, USA.
authors.forename: J H
authors.initials: JH
authors.lastname: Sullivan
authors.forename: R D
authors.initials: RD
authors.lastname: Moore
authors.forename: J C
authors.initials: JC
authors.lastname: Keruly
authors.forename: R E
authors.initials: RE
authors.lastname: Chaisson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009162:Mycobacterium avium; D018410:Pneumonia, Bacterial / Q000453:epidemiology* / Q000209:etiology; D011020:Pneumonia, Pneumocystis / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D014376:Tuberculosis / Q000453:epidemiology / Q000209:etiology
chemical_list: D019380:Anti-HIV Agents