Pneumococcal pneumonia not worse in HIV-infected, virologically suppressed patients

By Liz Meszaros, MDLinx
Published March 28, 2017

Key Takeaways

Pneumococcal pneumonia requiring hospitalization is not more severe in patients who are HIV-infected and virologically-suppressed via antiretroviral therapy (ART), compared to those who are not, and does not carry a worse prognosis, nor require different treatment, admissions, or care compared to that given the general population, according to research published in the March 13 issue of Chest.

“For the first time in the literature, the clinical presentation and outcomes of pneumococcal pneumonia in virologically suppressed HIV-infected patients with > 350 CD4+ T cells/mm3 has been investigated. No evidence was found of more severe presentations or worse clinical outcomes compared with uninfected patients,” explained lead author Catia Cillóniz, PhD, Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona, Barcelona, Spain. “These results support the fact that these patients do not need specific treatment, admission or sites of care different than the general population. This study may, therefore, impact national and international clinical guidelines on CAP,” she added.

Dr. Cillóniz and colleagues from the Hospital Clinic of Barcelona conducted this case-control study to compare 50 patients with virologically suppressed HIV infection (ART, CD4+ T cell count > 350 cells/mm3) with 100 non-HIV-infected controls, after infection with pneumococcal pneumonia. They compared length of stay (LOS), admission to intensive care units (ICU), and 30-day mortality.

“Among HIV-infected people, as in the general population, S. pneumoniae is the most frequent cause of bacterial pneumonia. The predisposition to invasive pneumococcal disease during HIV infection is probably due to dysfunctional host defenses. Virologically suppressed HIV-infected patients in our study was with ART therapy, and several studies demonstrated the high effective ART therapy reduced the risk of bacterial infections. Also, the patients in our study were young, with mainly low severity scores. The mortality rate is not surprising and is low according to the severity (PSI) score,” said Dr. Cillóniz.

The study was conducted from 2001-2016, and researchers matched controls by age, gender, comorbidities, and pneumonia diagnosis made in the same calendar period.

HIV-infected patients demonstrated higher rates of influenza compared to controls (14% vs 2%, respectively; P=0.007), as well as higher rates of pneumococcal vaccination (10% vs 1%; P=0.016), higher rates of hepatitis B virus (HBV) co-infection (6% vs 0%; P=0.036).

Researchers found that the following rates were similar between cases and controls:

  • ICU admission (18% vs 27%; P=0.22);
  • Need for mechanical ventilation (122% vs 8%; P=0.43);
  • Length of stay (7 days vs 7 days; P < 0.76); and
  • 30-day mortality (0% for both).

They found no evidence of a more severe presentation of pneumococcal pneumonia or of worse clinical outcomes in HIV-infected cases compared with controls.

“The most important finding of this study is that hospitalized HIV-infected patients with pneumococcal CAP did not have a more severe presentation or worse clinical outcome than uninfected patients. Also we found no evidence that HIV-infection was a risk factor for ICU admission or longer LOS. There are currently no specific guidelines or recommendations for virologically suppressed HIV-infected patients, and these results support the approach whereby these patients do not need specific treatments, admissions or sites of care that are different to the general population. Our results did not surprise us, it was what we hoped to prove,” concluded Dr. Cillóniz.

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