Journal Article

Bacterial Pneumonia, HIV Therapy, and Disease Progression among HIV-Infected Women in the HIV Epidemiologic Research (HER) Study

Rakhi Kohli, Yungtai Lo, Peter Homel, Timothy P. Flanigan, Lytt I. Gardner, Andrea A. Howard, Anne M. Rompalo, Galina Moskaleva, Paula Schuman and Ellie E. Schoenbaum

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 43, issue 1, pages 90-98
Published in print July 2006 | ISSN: 1058-4838
Published online July 2006 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/504871
Bacterial Pneumonia, HIV Therapy, and Disease Progression among HIV-Infected Women in the HIV Epidemiologic Research (HER) Study

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Background. To determine the rate and predictors of community-acquired bacterial pneumonia and its effect on human immunodeficiency virus (HIV) disease progression in HIV-infected women, we performed a multiple-site, prospective study of HIV-infected women in 4 cities in the United States.

Methods. During the period of 1993–2000, we observed 885 HIV-infected and 425 HIV-uninfected women with a history of injection drug use or high-risk sexual behavior. Participants underwent semiannual interviews, and CD4+ lymphocyte count and viral load were assessed in HIV-infected subjects. Data regarding episodes of bacterial pneumonia were ascertained from medical record reviews.

Results. The rate of bacterial pneumonia among 885 HIV-infected women was 8.5 cases per 100 person-years, compared with 0.7 cases per 100 person-years in 425 HIV-uninfected women (P < .001). In analyses limited to follow-up after 1 January 1996, highly active antiretroviral therapy (HAART) and trimethoprim-sulfamethoxazole (TMP-SMX) use were associated with a decreased risk of bacterial pneumonia. Among women who had used TMP-SMX for 12 months, each month of HAART decreased bacterial pneumonia risk by 8% (adjusted hazard ratio [HRadj], 0.92; 95% confidence interval [CI], 0.89–0.95). Increments of 50 CD4+ cells/mm3 decreased the risk (HRadj, 0.88; 95% CI, 0.84–0.93), and smoking doubled the risk (HRadj, 2.12; 95% CI, 1.26–3.55). Bacterial pneumonia increased mortality risk (HRadj, 5.02; 95% CI, 2.12–11.87), with adjustment for CD4+ lymphocyte count and duration of HAART and TMP-SMX use.

Conclusions. High rates of bacterial pneumonia persist among HIV-infected women. Although HAART and TMP-SMX treatment decreased the risk, bacterial pneumonia was associated with an accelerated progression to death. Interventions that improve HAART utilization and promote smoking cessation among HIV-infected women are warranted.

Journal Article.  4886 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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