Bacterial pulmonary infections occur commonly in persons infected with the human immunodeficiency virus (HIV) . The annual incidence of bacterial pneumonia in HIV-seropositive patients ranges from 5.5 to 29 per 100, compared with 0.7 to 10 per 100 in HIV-seronegative patients [2-4]. In developed countries, bacterial pathogens account for a majority of respiratory infections in HIV-infected individuals, particularly as Pneumocystis jirovecii incidence has declined profoundly in the era of highly effective antiretroviral therapy (HAART) [5,6].
RISK FACTORS FOR PNEUMONIA
Although bacterial pneumonias can occur throughout the course of HIV infection, they tend to develop more frequently in individuals with advanced immunosuppression [3,7].
Immune status — A direct relation between the CD4 count and the incidence of bacterial pneumonia was noted in a 2006 report: 4.9, 8.7, and 17.9 episodes occurred per 100 patient years with respective CD4 counts of >500, 200 to 500, and <200 cells/microL .
HIV infection is also a risk factor for recurrent pneumococcal pneumonia and bacteremia . (See "Invasive pneumococcal (Streptococcus pneumoniae) infections and bacteremia", section on 'HIV infection'.)
Based upon these observations, the Centers for Disease Control and Prevention (CDC) added recurrent bacterial pneumonia as an AIDS–defining condition in 1992 . Among HIV–infected patients, injection drug users (IDU), inner city inhabitants, smokers, and persons from developing countries are at highest risk for bacterial pneumonias [2,3,10,11].