title: Pneumonia in HIV-infected persons: increased risk with cigarette smoking and treatment interruption.
abstract: BACKGROUND
  Bacterial pneumonia is a major cause of morbidity for HIV-infected persons and contributes to excess mortality in this population.
  
  
  OBJECTIVE
  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.
  
  
  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 = 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.
  
  
  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.
authors.affiliation: Infectious Diseases (151B), Veterans Affairs Medical Center, 50 Irving Street, NW, Washington, DC 20422, USA. fred.gordin@med.va.gov
authors.forename: Fred M
authors.initials: FM
authors.lastname: Gordin
authors.forename: Mollie P
authors.initials: MP
authors.lastname: Roediger
authors.forename: Pierre-Marie
authors.initials: PM
authors.lastname: Girard
authors.forename: Jens D
authors.initials: JD
authors.lastname: Lundgren
authors.forename: Jose M
authors.initials: JM
authors.lastname: Miro
authors.forename: Adrian
authors.initials: A
authors.lastname: Palfreeman
authors.forename: Maria C
authors.initials: MC
authors.lastname: Rodriguez-Barradas
authors.forename: Marcelo J
authors.initials: MJ
authors.lastname: Wolff
authors.forename: Philippa J
authors.initials: PJ
authors.lastname: Easterbrook
authors.forename: Kate
authors.initials: K
authors.lastname: Clezy
authors.forename: Leonard N
authors.initials: LN
authors.lastname: Slater
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000453:epidemiology*; D011023:Pneumonia, Staphylococcal / Q000453:epidemiology; D016016:Proportional Hazards Models; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*
chemical_list: D044966:Anti-Retroviral Agents