Community-acquired pneumonia in HIV-infected patients: Updated insights on epidemiology and etiology

Bacterial pneumonia is a cause of HIV-associated morbidity and mortality. Recurrent pneumonia, defined as 2 or more episodes within a 12-month period, is an AIDS-defining illness. The prevalence of bacterial pulmonary infections in HIV-infected patients has been decreasing with the introduction and widespread use of antiretroviral therapy. In well-developed settings, the frequency of bacterial pneumonia in people living with HIV is comparable to that in the general population. Studies have shown that the cumulative incidence of pneumonia is higher in HIV-infected patients with advanced immunosuppression, airflow limitation, smoking, intravenous drug use, or in those from underdeveloped countries and urban areas. In HIV-infected patients with community-acquired bacterial pneumonia, Streptococcus pneumoniae and Haemophilus species are the most frequently isolated pathogens. However, in untreated or poorly adherent HIV-infected individuals, opportunistic infections may occur. Although the incidence of opportunistic infections among HIV-infected patients has declined in well-developed settings due to the widespread use of antiretroviral therapy, tuberculosis remains a serious threat and a major cause of morbidity and mortality among HIV-infected individuals worldwide. Early diagnosis of HIV infection, timely initiation of antiretroviral therapy with good adherence, and promotion of vaccination remain priorities. This editorial provides an overview of community-acquired pneumonia in HIV-infected patients and discusses recent changes in its epidemiology and etiology.