[Pneumopathies caused by Streptococcus pneumoniae in 27 HIV infected patients]

Determine the clinical features and outcome of acute pneumonia due to Streptococcus pneumoniae in HIV infected patients compared with non-HIV infected patients.

From January 1986 to February 1992, we observed 33 episodes of pneumococcal pneumonia in 27 HIV-infected patients. Most of the patients were drug addicts (16/27), and/or originated from Central Africa or Haiti (10/27). In 9/27 (33%) patients, HIV infection was previously unknown. Eleven of the 27 patients were at the CDC stages II-III and CD4 cell count was greater than 200/mm3 and CD8 cell count was greater than 1000/mm3 in 12/23 patients and 10/20 patients respectively.

In 10/33 episodes, respiratory symptoms were severe: bilateral pneumonia (n = 2) and/or hypoxaemia (n = 9). In 22/33 episodes, hospitalization occurred less than 24 h after the onset of symptoms and in 9/33 episodes, the initial chest X-ray was normal. Streptococcus pneumoniae was isolated in 16/33 episodes, from blood (n = 10), bronchoalveolar lavage (n = 3) or sputum (n = 3). Penicillin G or amoxicillin was used and allowed a favorable and quick response in all episodes. Recurrence occurred in 5/18 (27%) followed patients. These recurrences were not favoured by a low CD4 cell count since it was more than 200/mm3 in these five patients. However, the mean count of CD8 cells was higher in patients with recurrence than in patients without recurrence, 1990/mm3 versus 995/mm3 (p = 0.03).

CD8 hyperlymphocytosis could increase the risk of recurrence and would help identify a subgroup with higher risk of pneumococcal pneumonia among HIV infected persons.