Incidence and risk factors of bacterial pneumonia requiring hospitalization in HIV-infected patients started on a protease inhibitor-containing regimen

HIV Med. 2006 May;7(4):261-7. doi: 10.1111/j.1468-1293.2006.00370.x.


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.

MeSH terms

  • AIDS-Related Opportunistic Infections / blood
  • AIDS-Related Opportunistic Infections / drug therapy
  • AIDS-Related Opportunistic Infections / microbiology*
  • Age Factors
  • CD4 Lymphocyte Count
  • Drug Therapy, Combination
  • Female
  • HIV Protease Inhibitors / administration & dosage
  • HIV Protease Inhibitors / adverse effects*
  • HIV-1 / isolation & purification
  • Haemophilus influenzae / isolation & purification
  • Hospitalization*
  • Humans
  • Legionella pneumophila / isolation & purification
  • Male
  • Patient Compliance
  • Pneumonia, Bacterial / blood
  • Pneumonia, Bacterial / microbiology*
  • Prospective Studies
  • RNA, Viral / blood
  • Risk Factors
  • Saquinavir / administration & dosage
  • Saquinavir / adverse effects
  • Smoking / adverse effects
  • Streptococcus pneumoniae / isolation & purification
  • Substance Abuse, Intravenous / complications


  • HIV Protease Inhibitors
  • RNA, Viral
  • Saquinavir