Incidence and risk factors of bacterial pneumonia requiring hospitalization in HIV-infected patients started on a protease inhibitor-containing regimen.
OBJECTIVE
To describe the incidence and risk factors of bacterial pneumonia occurring in patients treated with antiretrovirals.


METHODS
In the ongoing APROCO (Anti-proteases) cohort, 1281 patients at the initiation of a protease inhibitor (PI)-containing antiretroviral regimen were enrolled from 1997-1999. All events requiring hospitalization during follow up are recorded. Of these, bacterial pneumonia was defined as the occurrence of a new pulmonary infiltrate with fever and either evidence of a bacteriological cause (definite cases) or favourable outcome with antimicrobial therapy (presumptive cases). Risk factors of bacterial pneumonia were studied using survival analyses.


RESULTS
During a median follow up of 43 months, 29 patients had at least one episode of bacterial pneumonia, giving an incidence of 0.8/100 patient years. The 11 definite cases were attributable to Streptococcus pneumoniae (n=9), Legionella pneumophila (n=1) and Haemophilus influenzae (n=1). In multivariate analysis, bacterial pneumonia was significantly more frequent in older patients, injecting drug users, patients having a CD4 cell count>500 cells/microL at baseline and patients who initiated PI therapy with nonboosted saquinavir. It was significantly less frequent in nonsmokers. The occurrence of bacterial pneumonia was also associated with lower self-reported adherence to antiretroviral therapy and to higher plasma HIV-1 RNA levels during follow-up.


CONCLUSIONS
Bacterial pneumonia occurs rarely in patients treated with a PI-containing regimen and may be associated with virological failure.
Le Moing
V
V
Infectious and Tropical Diseases Department, Hôpital Gui de Chauliac, Montpellier, France. v-le_moing@chu-montpellier.fr
Rabaud
C
C
Journot
V
V
Duval
X
X
Cuzin
L
L
Cassuto
J P
JP
Al Kaied
F
F
Dellamonica
P
P
Chêne
G
G
Raffi
F
F
D017088:AIDS-Related Opportunistic Infections / Q000097:blood / Q000188:drug therapy / Q000382:microbiology*; D000367:Age Factors; D018791:CD4 Lymphocyte Count; D004359:Drug Therapy, Combination; D005260:Female; D017320:HIV Protease Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D015497:HIV-1 / Q000302:isolation & purification; D006193:Haemophilus influenzae / Q000302:isolation & purification; D006760:Hospitalization; D006801:Humans; D016952:Legionella pneumophila / Q000302:isolation & purification; D008297:Male; D010349:Patient Compliance; D018410:Pneumonia, Bacterial / Q000097:blood / Q000382:microbiology*; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D012307:Risk Factors; D019258:Saquinavir / Q000008:administration & dosage / Q000009:adverse effects; D012907:Smoking / Q000009:adverse effects; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D015819:Substance Abuse, Intravenous / Q000150:complications
D017320:HIV Protease Inhibitors; D012367:RNA, Viral; D019258:Saquinavir