Pneumonia in HIV-infected persons: Increased risk with cigarette smoking and treatment interruption

Gordin, Fred M., Roediger, Mollie P., Girard, Pierre-Marie, Lundgren, Jens D., Miro, Jose M., Palfreeman, Adrian, Rodriguez-Barradas, Maria C., Wolff, Marcelo J., Easterbrook, Philippa J., Clezy, Kate, Slater, Leonard N., SMART study group and Emery, Sean (2008) Pneumonia in HIV-infected persons: Increased risk with cigarette smoking and treatment interruption. American Journal of Respiratory and Critical Care Medicine, 178 6: 630-636. doi:10.1164/rccm.200804-617OC


Author Gordin, Fred M.
Roediger, Mollie P.
Girard, Pierre-Marie
Lundgren, Jens D.
Miro, Jose M.
Palfreeman, Adrian
Rodriguez-Barradas, Maria C.
Wolff, Marcelo J.
Easterbrook, Philippa J.
Clezy, Kate
Slater, Leonard N.
SMART study group
Emery, Sean
Title Pneumonia in HIV-infected persons: Increased risk with cigarette smoking and treatment interruption
Journal name American Journal of Respiratory and Critical Care Medicine   Check publisher's open access policy
ISSN 1073-449X
1535-4970
Publication date 2008-09-01
Year available 2008
Sub-type Article (original research)
DOI 10.1164/rccm.200804-617OC
Open Access Status Not yet assessed
Volume 178
Issue 6
Start page 630
End page 636
Total pages 7
Place of publication New York, United States
Publisher American Thoracic Society
Language eng
Formatted abstract
Rationale: Bacterial pneumonia is a major cause of morbidity for HIV-infected persons and contributes to excess mortality in this population.

Objectives: To evaluate the frequency and risk factors for occurrence of bacterial pneumonia in the present era of potent antiretroviral therapy.

Methods: We evaluated data from a randomized trial of episodic antiretroviral therapy. The study, Strategies for Management of Antiretroviral Therapy, enrolled 5,472 participants at 318 sites in 33 countries. Study patients had more than 350 CD4 cells at baseline. Diagnosis of bacterial pneumonia was confirmed by a blinded clinical-events committee.

Measurements and Main Results: During a mean follow-up of 16 months, 116 participants (2.2%) developed at least one episode of bacterial pneumonia. Patients randomized to receive episodic antiretroviral therapy were significantly more likely to develop pneumonia than patients randomized to receive continuous antiretroviral therapy (hazard ratio, 1.55; 95% confidence interval, 1.07–2.25; P = 0.02). Cigarette smoking was a major risk factor: Current-smokers had more than an 80% higher risk of pneumonia compared with never-smokers (hazard ratio, 1.82; 95% confidence interval, 1.09–3.04; P = 0.02). Participants who were on continuous HIV treatment and were current smokers were three times more likely to develop bacterial pneumonia than nonsmokers. Current smoking status was significant, but a past history of smoking was not.

Conclusions: Bacterial pneumonia is a major source of morbidity, even for persons on potent antiretroviral therapy, including those with high CD4 cells. Efforts to reduce this illness should stress the importance of uninterrupted antiretroviral therapy and attainment and/or maintenance of nonsmoking status.
Keyword Bacterial infections
HIV
Pneumonia
Smoking
Q-Index Code C1
Q-Index Status Provisional Code
Grant ID G0200585
U01AI042170
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: Faculty of Medicine
 
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