Community-Acquired Pneumococcal Pneumonia Treatment Outcomes in HIV Immunosuppression

Adults with community-acquired pneumococcal pneumonia (CAPP) who are HIV-immunosuppressed had the same prognosis and outcomes with standardized treatment compared with adults not infected with HIV, according to a study published in the Chest Journal. 

Researchers identified 50 patients infected with HIV on antiretroviral therapy (ART) with >350 CD4 cells/mm³ and acutely infected with CAPP and compared them with a control group of 100 patients infected with CAPP but not HIV-immunosuppressed. 

There were no significant differences in baseline characteristics, with the exception that patients infected with HIV had higher rates of influenza and pneumococcal vaccinations compared with the control group. Both groups were treated with the same standardized empiric antibiotic treatment regimen. 

Intensive care unit admission rates (18% vs 27%; P =.22), mechanical ventilation requirements (12% vs 8%; P =.43), and length of stay (7 days vs 7 days; P =.76) were similar in both groups. No patients died during the study.

Study limitations included a small sample size and completion of the study in a single academic hospital in Spain, with data difficult to generalize globally.

The most significant finding was that specific treatment guidelines are clinically unnecessary when treating adults immunosuppressed by HIV on ART with >350 CD4 cells/mm³ who are acutely infected with CAPP compared with current standard treatment in the general population infected with CAPP as no statistically significant different outcomes were identified in the 2 groups.

Reference 

Cilloniz C, Torres A, Manzardo C, et al. Community-acquired pneumococcal pneumonia in virologically suppressed HIV-infected adult patients. A matched case-control study. Chest. 2017;152(2):295-303.