[Bacterial pneumonia as a risk marker for new bacterial diseases in patients with HIV infection]

Bacterial pneumonias are a main cause of morbidity and mortality among patients infected by the HIV. Furthermore, recent data suggest that, under certain circumstances, they can be prognostic markers.

The evolution of a cohort of HIV-infected patients, prospectively defined by having suffered a pneumonia, was studied with regards to the occurrence of a new pneumonia or death from a bacterial disease; the evolution of a control cohort of patients matched according to sex, CD4-cell count, previous HIV-disease and zidovudine-treatment was compared to the former cohort by means of survival-analysis techniques.

Forty-nine patients in each group were followed up for a total of 1389 and 1893 patient-months respectively. In the first group, 17 new first pneumonia episodes were diagnosed, as compared to 7 in the second group (relative-risk: 3.23, 95% confidence interval: 1.34 to 7.79, p = 0.005). Eight of the 31 deaths that occurred in the first group were attributed to a bacterial disease, as compared to none of the 24 deaths in the second group (p = 0.007, Fisher's exact test) (in five of those cases, a bacteria was isolated which was thought to be directly related to the death).

HIV-infected patients who suffer a bacterial pneumonia have an increased risk of suffering new severe bacterial diseases (pneumonia or fatal diseases) as compared to HIV-infected patients with similar prognostic features but no previous episodes of pneumonia.