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Pyogenic bacterial lower respiratory tract infection in human immunodeficiency virus-infected patients

Respiratory Division, Tenon Hospital, Paris, France

CORRESPONDENCE: C. Mayaud, Service de Pneumologie et de Réanimation respiratoire, Hôpital Tenon, AP-HP, 4 rue de la Chine, 75020, Paris, France. Fax: 33 156017002. E-mail: charles.mayaud@tnn.ap-hop-paris.fr

Keywords: acquired immune deficiency syndrome, bacterial bronchitis, bacterial pneumonia, human immunodeficiency virus infection, prophylaxis

Received: February 5, 2002
Accepted March 18, 2002

In human immunodeficiency virus (HIV)-infected patients, bacterial lower respiratory tract infections are the most frequent respiratory diseases. They are frequently the first clinical manifestation of HIV infection.

The incidence and severity of bacterial lower respiratory tract infections increase with the degree of immunosuppression. At the acquired immune deficiency syndrome (AIDS) stage, the responsible bacteria and clinical presentation may be atypical. Bacterial pneumonia may be fatal, particularly in AIDS patients, and its occurrence is predictive of a reduced survival time.

Pneumococcal vaccine is recommended in patients with a CD4 T-lymphocyte count of >200 cells·mm^–3 and cotrimoxazole (trimethoprim/sulfamethoxazole) in patients with a CD4 T-lymphocyte count of <200 cells·mm^–3. Unfortunately, such prophylaxis remains insufficiently prescribed and its protective effect is limited.

Highly active antiretroviral treatment has dramatically reduced the incidence of lower respiratory tract infection due to Pseudomonas aeruginosa and opportunistic bacteria. In contrast, successful highly active antiretroviral therapy slightly decreased the risk of bacterial pneumonia due to usual bacteria, even in patients on successful highly active antiretroviral therapy.