Pneumonia in HIV-infected patients: a case-control survey of factors involved in risk and prevention

AIDS. 1999 Oct 1;13(14):1971-5. doi: 10.1097/00002030-199910010-00021.


Objective: To assess the factors that increase or decrease the risk of pneumonia with particular attention to immunization with pneumococcal and influenza vaccines in a group of HIV-infected persons.

Design: A retrospective, case-control study based on information entered into a standard database and the medical record.

Setting: Patients attending a referral clinic specializing in AIDS/HIV care at a public hospital.

Patients: Among over 2000 subjects entered into a database in 8 years, 127 incidents of pneumonia were identified from the record. These cases were matched with 127 CD4 cell count matched, concurrent controls.

Interventions: None.

Main outcome measure: The principal hypothesis was that chart review would find a decreased frequency of pneumococcal immunization in the pneumonia cases compared with matched controls.

Results: Pneumococcal immunization was associated with a reduction of the risk of pneumonia by nearly 70%. The effect was seen even when immunization was given with a CD4 cell count of less than 100/mm3. Injection drug users and African-Americans had a twofold increased risk of pneumonia.

Conclusion: The study provides data to support the current recommendation for pneumococcal immunization of all HIV-infected persons. Although this conclusion could lead to renewed enthusiasm for increasing pneumococcal immunization rates in HIV-infected persons, it must be recognized that the study is observational and ascertainment bias cannot be excluded.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • AIDS-Related Opportunistic Infections / epidemiology
  • AIDS-Related Opportunistic Infections / immunology
  • AIDS-Related Opportunistic Infections / prevention & control*
  • Adolescent
  • Adult
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Databases, Factual
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pneumonia, Pneumocystis / epidemiology
  • Pneumonia, Pneumocystis / immunology
  • Pneumonia, Pneumocystis / prevention & control*
  • Retrospective Studies
  • Risk Factors