Bacterial pneumonia in HIV-infected patients: use of the pneumonia severity index and impact of current management on incidence, aetiology and outcome

HIV Med. 2008 Oct;9(8):609-15. doi: 10.1111/j.1468-1293.2008.00603.x. Epub 2008 Jun 28.


Objectives: Despite a recent decrease, bacterial pneumonia (BP) is still the most common admission diagnosis in HIV patients. We analyse BP incidence, characteristics and prevention measures.

Methods: Observational study of all patients hospitalized for BP in a tertiary hospital in Barcelona, Spain, from January 2000 to December 2005. Demographic and HIV-related data, BP risk factors, characteristics of BP and outcomes are analysed.

Results: One hundred and eighty-six BP episodes in 161 patients were included; patients were mainly male (73.7%) and intravenous drug users (73.7%). A decrease in BP incidence was seen during the study period, especially in vaccinated patients. The most commonly isolated microorganism was Streptococcus pneumoniae (31.7%), followed by Legionella pneumophila (5.9%). Legionella pneumophila was more likely in patients with undetectable viral load, higher CD4 cell counts or prior vaccination. Highly active antiretroviral therapy, cotrimoxazole prophylaxis and pneumococcal vaccination did not have a significant influence on bacteraemia rate, in-hospital complications or BP mortality. High Pneumonia Severity Index (PSI) predicted mortality accurately [relative risk 15.2, 95% confidence interval 3.2-71.7; P=0.001]. Mortality was 9.1%, but was significantly higher in patients with CD4 counts under 200 cells/microL (P=0.022).

Conclusions: A decline in BP incidence was seen during the study period. Combining CD4 cell count and PSI score could become a good strategy in deciding which patients have to be hospitalized.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • AIDS-Related Opportunistic Infections / drug therapy
  • AIDS-Related Opportunistic Infections / epidemiology
  • AIDS-Related Opportunistic Infections / microbiology*
  • Adult
  • Anti-HIV Agents / therapeutic use*
  • CD4 Lymphocyte Count
  • Female
  • HIV Infections / drug therapy
  • HIV Infections / microbiology*
  • HIV-1*
  • Health Status Indicators
  • Humans
  • Incidence
  • Legionella pneumophila
  • Legionnaires' Disease / drug therapy
  • Legionnaires' Disease / epidemiology
  • Legionnaires' Disease / virology
  • Male
  • Middle Aged
  • Pneumonia, Bacterial / drug therapy
  • Pneumonia, Bacterial / epidemiology
  • Pneumonia, Bacterial / virology*
  • Pneumonia, Pneumococcal / drug therapy
  • Pneumonia, Pneumococcal / epidemiology
  • Pneumonia, Pneumococcal / virology
  • Regression Analysis
  • Risk Factors
  • Spain / epidemiology
  • Substance Abuse, Intravenous
  • Treatment Outcome


  • Anti-HIV Agents