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Treating HIV-Positive/Non-AIDS Patients for Community-Acquired Pneumonia with ART

  • Respiratory Infections (F Arnold, Section Editor)
  • Published:
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Abstract

Purpose of Review

This article reviews the most recent publications on community-acquired pneumonia (CAP) in the HIV-infected population on antiretroviral therapy (ART), focusing on epidemiology, prognostic factors, etiology, and antimicrobial therapy. The data discussed here were mainly obtained from a non-systematic review using Medline and references from relevant articles.

Recent Findings

CAP remains a major cause of morbidity and mortality among HIV-infected patients and incurs high health costs despite the introduction of ART.

Summary

HIV-infected patients are generally known to be more susceptible to bacterial pneumonia. Streptococcus pneumoniae is the most frequently reported pathogen in HIV-infected patients on ART, who present a higher rate of bacteremia than non-HIV-infected patients. Several studies have also examined microbial etiology and prognostic factors of CAP in HIV-infected patients on ART. Despite the high rate of bacterial pneumonia in these patients, mortality rates are not higher than in patients without HIV infection.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. WHO | HIV/AIDS [Internet]. WHO. [cited 2018 Jan 23]. Available from: http://www.who.int/gho/hiv/en/

  2. UNAIDS. Fact Sheet: World AIDS Day 2017 global HIV statistics [Internet]. Available from: http://www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_en.pdf

  3. Becerra JC, Bildstein LS, Gach JS. Recent insights into the HIV/AIDS pandemic. Microb Cell Graz Austria. 2016;3(9):451–75.

    CAS  Google Scholar 

  4. Benito N, Moreno A, Miro JM, Torres A. Pulmonary infections in HIV-infected patients: an update in the 21st century. Eur Respir J. 2012;39(3):730–45.

    Article  CAS  PubMed  Google Scholar 

  5. Gordin FM, Roediger MP, Girard P-M, Lundgren JD, Miro JM, Palfreeman A, et al. Pneumonia in HIV-infected persons: increased risk with cigarette smoking and treatment interruption. Am J Respir Crit Care Med. 2008;178(6):630–6.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Pulmonary Complications of HIV [Internet]. European Respiratory Society; 2014. 277 p. Available from: http://books.ersjournals.com/content/9781849840552/9781849840552

  7. •• Feldman C, Anderson R, Rossouw T. HIV-related pneumococcal disease prevention in adults. Expert Rev Respir Med. 2017;11(3):181–99. Important review article about pneumococcal disease in HIV-infected patients

    Article  CAS  PubMed  Google Scholar 

  8. Torres A, Peetermans WE, Viegi G, Blasi F. Risk factors for community-acquired pneumonia in adults in Europe: a literature review. Thorax. 2013 Nov;68(11):1057–65.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Feldman C, Anderson R. HIV-associated bacterial pneumonia. Clin Chest Med. 2013 Jun;34(2):205–16.

    Article  PubMed  Google Scholar 

  10. Curran A, Falcó V, Crespo M, Martinez X, Ribera E, Villar del Saz S, et al. Bacterial pneumonia in HIV-infected patients: use of the pneumonia severity index and impact of current management on incidence, aetiology and outcome. HIV Med. 2008;9(8):609–15.

    Article  CAS  PubMed  Google Scholar 

  11. Akgün KM, Tate JP, Pisani M, Fried T, Butt AA, Gibert CL, et al. Medical ICU admission diagnoses and outcomes in human immunodeficiency virus-infected and virus-uninfected veterans in the combination antiretroviral era. Crit Care Med. 2013;41(6):1458–67.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Akgün KM, Pisani M, Crothers K. The changing epidemiology of HIV-infected patients in the intensive care unit. J Intensive Care Med. 2011;26(3):151–64.

    Article  PubMed  Google Scholar 

  13. •• Cilloniz C, Torres A, Polverino E, Gabarrus A, Amaro R, Moreno E, et al. Community-acquired lung respiratory infections in HIV-infected patients: microbial aetiology and outcome. Eur Respir J. 2014;43(6):1698–708. Important data of a study performed in a high-income setting exemplifies how bacterial agents have taken over P. jirovecii as the main microbial etiology of CAP

    Article  CAS  PubMed  Google Scholar 

  14. • Cillóniz C, Torres A, Manzardo C, Gabarrús A, Ambrosioni J, Salazar A, et al. Community-acquired pneumococcal pneumonia in virologically suppressed HIV-infected adult patients: a matched case-control study. Chest. 2017; Important study about clinical presentation and outcome of pneumococcal CAP in HIV-infected patients virologically suppressed

  15. Chowers M, Regev-Yochay G, Mor O, Cohen-Poradosu R, Riesenberg K, Zimhony O, et al. Invasive pneumococcal disease (IPD) in HIV infected patients in Israel since the introduction of pneumococcal conjugated vaccines (PCV): analysis of a nationwide surveillance study, 2009–2014. Hum Vaccines Immunother. 2017;13(1):216–9.

    Article  Google Scholar 

  16. Siemieniuk RAC, Gregson DB, Gill MJ. The persisting burden of invasive pneumococcal disease in HIV patients: an observational cohort study. BMC Infect Dis. 2011;11:314.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Lee K-Y, Tsai M-S, Kuo K-C, Tsai J-C, Sun H-Y, Cheng AC, et al. Pneumococcal vaccination among HIV-infected adult patients in the era of combination antiretroviral therapy. Hum Vaccines Immunother. 2014;10(12):3700–10.

    Article  Google Scholar 

  18. Hull MW, Phillips P, Montaner JSG. Changing global epidemiology of pulmonary manifestations of HIV/AIDS. Chest. 2008;134(6):1287–98.

    Article  PubMed  Google Scholar 

  19. Lamas CC, Coelho LE, Grinsztejn BJ, Veloso VG. Community-acquired lower respiratory tract infections in HIV-infected patients on antiretroviral therapy: predictors in a contemporary cohort study. Infection. 2017;45(6):801–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Søgaard OS, Reekie J, Ristola M, Jevtovic D, Karpov I, Beniowski M, et al. Severe bacterial non-aids infections in HIV-positive persons: incidence rates and risk factors. J Inf Secur. 2013;66(5):439–46.

    Google Scholar 

  21. Mussini C, Galli L, Lepri AC, De Luca A, Antinori A, Libertone R, et al. Incidence, timing, and determinants of bacterial pneumonia among HIV-infected patients: data from the ICONA Foundation Cohort. J Acquir Immune Defic Syndr 1999. 2013;63(3):339–45.

    Article  CAS  Google Scholar 

  22. Adlakha A, Pavlou M, Walker DA, Copas AJ, Dufty N, Batson S, et al. Survival of HIV-infected patients admitted to the intensive care unit in the era of highly active antiretroviral therapy. Int J STD AIDS. 2011 Sep;22(9):498–504.

    Article  CAS  PubMed  Google Scholar 

  23. Sharvill R, Fernandes A, Allen K, Astin J. Adopting universal testing for HIV in intensive care for patients admitted with severe pneumonia: results from our change in practice. Int J STD AIDS. 2017;28(1):88–90.

    Article  PubMed  Google Scholar 

  24. Raju R, Peters BS, Breen RAM. Lung infections in the HIV-infected adult. Curr Opin Pulm Med. 2012;18(3):253–8.

    Article  PubMed  Google Scholar 

  25. Capocci S, Lipman M. Respiratory infections in HIV-infected adults: epidemiology, clinical features, diagnosis and treatment. Curr Opin Pulm Med. 2013;19(3):238–43.

    Article  CAS  PubMed  Google Scholar 

  26. Almeida A, Boattini M. Community-acquired pneumonia in HIV-positive patients: an update on etiologies, epidemiology and management. Curr Infect Dis Rep. 2017;19(1):2.

    Article  PubMed  Google Scholar 

  27. Perelló R, Miró O, Marcos MA, Almela M, Bragulat E, Sánchez M, et al. Predicting bacteremic pneumonia in HIV-1-infected patients consulting the ED. Am J Emerg Med. 2010;28(4):454–9.

    Article  PubMed  Google Scholar 

  28. López-Palomo C, Martín-Zamorano M, Benítez E, Fernández-Gutiérrez C, Guerrero F, Rodríguez-Iglesias M, et al. Pneumonia in HIV-infected patients in the HAART era: incidence, risk, and impact of the pneumococcal vaccination. J Med Virol. 2004;72(4):517–24.

    Article  CAS  PubMed  Google Scholar 

  29. Sadikot RT, Blackwell TS, Christman JW, Prince AS. Pathogen-host interactions in Pseudomonas aeruginosa pneumonia. Am J Respir Crit Care Med. 2005;171(11):1209–23.

    Article  PubMed  PubMed Central  Google Scholar 

  30. • Head BM, Trajtman A, Rueda ZV, Vélez L, Keynan Y. Atypical bacterial pneumonia in the HIV-infected population. Pneumonia Nathan Qld. 2017;9:12. Important review about the intracellular pathogens causing CAP in HIV patients

    Article  PubMed  PubMed Central  Google Scholar 

  31. Cillóniz C, Miguel-Escuder L, Pedro-Bonet ML, Falcó V, Lopez Y, García-Vidal C, et al. Community-acquired Legionella pneumonia in HIV-infected adult patients: a matched case-control study. Clin Infect Dis Off Publ Infect Dis Soc Am. 2018 Apr 12;

  32. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997;336(4):243–50.

    Article  CAS  PubMed  Google Scholar 

  33. Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003 May;58(5):377–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Almeida A, Almeida AR, Castelo Branco S, Vesza Z, Pereira R. CURB-65 and other markers of illness severity in community-acquired pneumonia among HIV-positive patients. Int J STD AIDS. 2016 Oct;27(11):998–1004.

    Article  PubMed  Google Scholar 

  35. Camon S, Quiros C, Saubi N, Moreno A, Marcos MA, Eto Y, et al. Full blood count values as a predictor of poor outcome of pneumonia among HIV-infected patients. BMC Infect Dis. 2018;18(1):189.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Garau J, Baquero F, Pérez-Trallero E, Pérez J-L, Martín-Sánchez AM, García-Rey C, et al. Factors impacting on length of stay and mortality of community-acquired pneumonia. Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis. 2008;14(4):322–9.

    CAS  Google Scholar 

  37. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis Off Publ Infect Dis Soc Am. 2007;44(Suppl 2):S27–72.

    Article  CAS  Google Scholar 

  38. Lim WS, Baudouin SV, George RC, Hill AT, Jamieson C, Le Jeune I, et al. BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009;64(Suppl 3):iii1–55.

    Article  PubMed  Google Scholar 

  39. Torres A, Lee N, Cilloniz C, Vila J, Van der Eerden M. Laboratory diagnosis of pneumonia in the molecular age. Eur Respir J. 2016;48(6):1764–78.

    Article  CAS  PubMed  Google Scholar 

  40. Dickson RP, Erb-Downward JR, Huffnagle GB. The role of the bacterial microbiome in lung disease. Expert Rev Respir Med. 2013;7(3):245–57.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. • Shenoy MK, Lynch SV. Role of the lung microbiome in HIV pathogenesis. Curr Opin HIV AIDS. 2018;13(1):45–52. An interesting review about microbiome in HIV-infected population.

    Article  CAS  PubMed  Google Scholar 

  42. • Iwai S, Fei M, Huang D, Fong S, Subramanian A, Grieco K, et al. Oral and airway microbiota in HIV-infected pneumonia patients. J Clin Microbiol. 2012;50(9):2995–3002. Important study compared lung microbioma between HIV-infected and non-HIV-infected pneumonia patients

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Iwai S, Huang D, Fong S, Jarlsberg LG, Worodria W, Yoo S, et al. The lung microbiome of Ugandan HIV-infected pneumonia patients is compositionally and functionally distinct from that of San Franciscan patients. PLoS One. 2014;9(4):e95726.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Torres A, Barberán J, Falguera M, Menéndez R, Molina J, Olaechea P, et al. Multidisciplinary guidelines for the management of community-acquired pneumonia. Med Clin (Barc). 2013;140(5):223.e1–223.e19.

    Article  Google Scholar 

  45. Woodhead M, Blasi F, Ewig S, Garau J, Huchon G, Ieven M, et al. Guidelines for the management of adult lower respiratory tract infections—full version. Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis. 2011;17(Suppl 6):E1–59.

    Google Scholar 

  46. Peters PJ, Skarbinski J, Louie JK, Jain S, New York City Department of Health Swine Flu Investigation Team, Roland M, et al. HIV-infected hospitalized patients with 2009 pandemic influenza A (pH1N1)—United States, spring and summer 2009. Clin Infect Dis Off Publ Infect Dis Soc Am. 2011;52(Suppl 1):S183–8.

    Article  Google Scholar 

  47. Martínez E, Marcos MA, Hoyo-Ulloa I, Antón A, Sánchez M, Vilella A, et al. Influenza A H1N1 in HIV-infected adults. HIV Med. 2011;12(4):236–45.

    Article  PubMed  Google Scholar 

  48. Ormsby CE, de la Rosa-Zamboni D, Vázquez-Pérez J, Ablanedo-Terrazas Y, Vega-Barrientos R, Gómez-Palacio M, et al. Severe 2009 pandemic influenza A (H1N1) infection and increased mortality in patients with late and advanced HIV disease. AIDS Lond Engl. 2011;25(4):435–9.

    Article  CAS  Google Scholar 

  49. Liverpool HIV Interactions [Internet]. [cited 2018 May 24]. Available from: https://www.hiv-druginteractions.org/checker

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Acknowledgments

The authors take full responsibility for the content of this article. Dr. Catia Cillóniz is a recipient of a Postdoctoral Grant “Strategic plan for research and innovation in health-PERIS 2016-2020.”

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Authors and Affiliations

  1. Department of Pulmonary Medicine, Institut Clinic del Tórax, Hospital Clinic of Barcelona – Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB) - SGR 911- Ciber de Enfermedades Respiratorias (Ciberes), C/ Villarroel 170, 08036, Barcelona, Spain

    Catia Cillóniz & Antoni Torres

  2. Department of Medicine and Surgery, Respiratory Disease, and Lung Function Unit, University of Parma, Parma, Italy

    Antonella Ielpo

Authors
  1. Catia Cillóniz
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  2. Antonella Ielpo
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  3. Antoni Torres
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Correspondence to Catia Cillóniz or Antoni Torres.

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Catia Cillóniz, Antonella Ielpo and Antoni Torres no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Respiratory Infections

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Cillóniz, C., Ielpo, A. & Torres, A. Treating HIV-Positive/Non-AIDS Patients for Community-Acquired Pneumonia with ART. Curr Infect Dis Rep 20, 46 (2018). https://doi.org/10.1007/s11908-018-0652-7

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